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Gaddis JM, Shults E, Laboret B, Bialaszewski R, Wells K, South C, Wells JE. Understanding Hip Pain Through Social Media: An Initial Overview of an International Web-Based Survey. Arthroplast Today 2025; 32:101625. [PMID: 40026485 PMCID: PMC11871486 DOI: 10.1016/j.artd.2025.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/06/2025] [Accepted: 01/14/2025] [Indexed: 03/05/2025] Open
Abstract
Background We aimed to understand the adult experience of hip pain through a web-based REDCap platform via social media. The purpose of this study was to assess the possibility of collecting patient-reported data through social media in people with hip pain while outlining the contents of the survey and analyzing the demographics of the sample population. Methods The survey link was active from October 1, 2023, to May 1, 2024, and available on social media platforms. Respondents provided consent prior to survey participation. Responses were anonymous, and only unique, fully complete surveys were analyzed. The comprehensive hip survey included demographic and overall health reporting, as well as hip-specific diagnoses, hip-specific functional measures, and mental health outcomes. Results Six hundred twenty-seven surveys were initiated, with 509 surveys completed. Twenty-six countries were represented with most responses originating from the United States (72.1%, n = 367), United Kingdom (10%, n = 51), Canada (5.5%, n = 28), and Australia (4.1%, n = 21). Ninety-three percent of respondents were women, with a mean age of 39 (range: 18-77). Top diagnoses reported were hip dysplasia (60.9%, n = 310), femoroacetabular impingement syndrome (45.2%, n = 230), Perthes disease (6.4%, n = 33), and osteoarthritis (6.3%, n = 32). Seventy-one percent (n = 366) reported previous hip surgery, with hip arthroscopy (60.7%, n = 222), periacetabular osteotomy (50.3%, n = 184), and total hip arthroplasty (24.3%, n = 89) being the most reported procedures. Conclusions This study demonstrates the feasibility of utilizing social media for a comprehensive web-based survey to gather patient-reported outcomes from individuals with various sources of hip pain internationally.
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Affiliation(s)
- John M. Gaddis
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | | | - Bretton Laboret
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ryan Bialaszewski
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Katerina Wells
- Baylor University Medical Center, Department of Colorectal Surgery, Dallas, TX, USA
| | | | - Joel E. Wells
- Baylor Scott and White Hip Preservation Center, Department of Orthopedic Surgery, McKinney, TX, USA
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Bourantas CA, Behrman EC, Shepherd MC, Lohse KR, Clohisy JC, Harris MD. Dynamic femoral head coverage following periacetabular osteotomy for developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2025; 124:106471. [PMID: 40024201 PMCID: PMC11993322 DOI: 10.1016/j.clinbiomech.2025.106471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 02/05/2025] [Accepted: 02/21/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND Developmental dysplasia of the hip reduces hip stability due to insufficient femoral head coverage. Periacetabular osteotomy surgery aims to increase this coverage. Typically measured using radiographs, most coverage assessments are limited to static hip positions and cannot capture 3D anatomy. This study quantified how dynamic 3D femoral coverage changes during gait and squat after periacetabular osteotomy surgery and compared dynamic coverage to static measures. METHODS Pre- and post-surgery CT scans from 38 patients with hip dysplasia were used to reconstruct 3D femur and pelvis bones with which gait and squat were simulated. Models of 38 control subjects were also created. The femoral head was divided into anteromedial, anterolateral, posteromedial, and posterolateral regions. Regional coverage was compared pre- and post-surgery, and against controls, in a static neutral position, during the stance phase of gait, and throughout the squat cycle. FINDINGS Lateral coverage increased post-surgery in the static neutral position (anterolateral: 4.9 ± 3.6 % to 13.8 ± 5.6 %; posterolateral: 22.9 ± 15.4 % to 39.8 ± 15.2 % (p ≤ 0.001)) and throughout gait and squat (p ≤ 0.001). Average changes in neutral anterolateral coverage (+8.9 ± 4.5 %) were similar to average changes during gait (+8.1 ± 3.0 %), but not squat (+12.0 ± 1.9 %). Static neutral coverage post-surgery differed significantly from dynamic coverage in every region of the femoral head during all of gait, and most of squat. INTERPRETATION While static measures follow some patterns of dynamic coverage after surgery, they miss important variations that can impact joint loading. Understanding how periacetabular osteotomy changes dynamic femoral head coverage can aid with operative planning and assessment to optimize outcomes during daily activities.
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Affiliation(s)
- Christina A Bourantas
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Emma C Behrman
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Molly C Shepherd
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael D Harris
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA.
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Ağlamış Ö, Akkaya SK, Erol B, Yılmaz Ergani S. Investigating the Impact of Acetabular Dysplasia on Sexual Dysfunction and Psychological Well-Being in Women. J Clin Med 2025; 14:2385. [PMID: 40217835 PMCID: PMC11989633 DOI: 10.3390/jcm14072385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 03/22/2025] [Accepted: 03/28/2025] [Indexed: 04/14/2025] Open
Abstract
Background: This study aimed to explore the relationship between acetabular dysplasia (AD), a known risk factor for pelvic floor dysfunction (PFD), and its effects on sexual function and psychological well-being in women. Methods: A cross-sectional study was conducted with 125 female patients experiencing genitopelvic pain and penetrative disorders. Participants were categorized into AD-positive and AD-negative groups based on anteroposterior pelvic radiographs. Sexual function was evaluated using the Golombok-Rust Sexual Satisfaction Inventory (GRISS), while pain and psychological well-being were assessed using the Visual Analog Scale (VAS) and the Beck Depression Inventory (BDI), respectively. Results: Results showed that AD-positive patients had significantly higher pain (VAS: 8.15 ± 1.1, p < 0.001) and anxiety scores (BDI: 12.3 ± 11.0, p < 0.02). Sexual function was notably impaired in the AD-positive group, with lower sexual satisfaction and a higher prevalence of anorgasmia (p = 0.01). The AD-negative group demonstrated better scores in frequency and satisfaction with touch (p = 0.04, p = 0.03). Additionally, AD-positive patients exhibited limited hip rotation and a higher incidence of osteoarthritis and Legg-Calvé-Perthes disease. Conclusions: This study highlights the broader impact of AD on women's quality of life, emphasizing the need for targeted therapeutic interventions to address sexual dysfunction and psychological distress in affected patients.
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Affiliation(s)
- Özgür Ağlamış
- Departmant of Obstetrics and Gynecology, Private Clinic, 34360 Istanbul, Turkey; (Ö.A.); (S.K.A.)
| | - Selver Kübra Akkaya
- Departmant of Obstetrics and Gynecology, Private Clinic, 34360 Istanbul, Turkey; (Ö.A.); (S.K.A.)
| | - Burcu Erol
- Departmant of Obstetrics and Gynecology, Ordu Training and Research Hospital, 52200 Ordu, Turkey;
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Asturias A, Kiani S, Sadjadi R, Swarup I. The Treatment of Hip Dysplasia in Adolescent Patients. Curr Rev Musculoskelet Med 2025:10.1007/s12178-025-09953-y. [PMID: 40038222 DOI: 10.1007/s12178-025-09953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2025] [Indexed: 03/06/2025]
Abstract
PURPOSE OF REVIEW Adolescent hip dysplasia represents a unique challenge for pediatric orthopaedic surgeons. The disease spectrum is broad and the complications of untreated disease can be severe. The purpose of this review is to provide a framework for understanding and treating adolescent hip dysplasia and when to consider nonoperative versus operative interventions. RECENT FINDINGS Combined hip arthroscopy and periacetabular osteotomy may be considered for patients with concomitant symptomatic labral tears, which is often diagnosed by history and advanced imaging. Hip dysplasia in adolescent patients is an important diagnosis. There are various clinical and radiographic parameters and the most important ones are lateral center edge angle, Tonnis grade, and joint congruency. Management is based on symptoms and radiographic findings. Nonoperative management is typically recommended for patients with symptomatic borderline dysplasia. Surgical management includes periacetabular osteotomy for patients with symptomatic hip dysplasia that have failed nonoperative treatment. Concomitant hip arthroscopy may be considered for patients with symptomatic labral tear, but is generally not recommended in isolation if there is evidence of dysplasia. Outcomes are generally good after operative management of hip dysplasia in adolescent patients.
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Affiliation(s)
- Alicia Asturias
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA.
| | - Sara Kiani
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA
| | - Ryan Sadjadi
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA
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Alshaikhsalama A, Archer H, Xi Y, Ljuhar R, Wells JE, Chhabra A. HIPPO artificial intelligence: Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia. World J Exp Med 2024; 14:99359. [PMID: 39713082 PMCID: PMC11551701 DOI: 10.5493/wjem.v14.i4.99359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 09/23/2024] [Accepted: 10/24/2024] [Indexed: 10/31/2024] Open
Abstract
BACKGROUND Hip dysplasia (HD) is characterized by insufficient acetabular coverage of the femoral head, leading to a predisposition for osteoarthritis. While radiographic measurements such as the lateral center edge angle (LCEA) and Tönnis angle are essential in evaluating HD severity, patient-reported outcome measures (PROMs) offer insights into the subjective health impact on patients. AIM To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence (AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs. METHODS Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database. Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score (HHS), international hip outcome tool (iHOT-12), short form (SF) 12 (SF-12), and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation. RESULTS The median patient age was 28.6 years (range 15.7-62.3 years) with 82.3% of patients being women and 17.7% being men. The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds, respectively. Manual measurements exhibited weak correlations with HHS, including LCEA (r = 0.18) and Tönnis angle (r = -0.24). AI-derived metrics showed similar weak correlations, with the most significant being Caput-Collum-Diaphyseal (CCD) with iHOT-12 at r = -0.25 (P = 0.042) and CCD with SF-12 at r = 0.25 (P = 0.048). Other measured correlations were not significant (P > 0.05). CONCLUSION This study suggests AI can aid in HD assessment, but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes, complementing AI-derived measurements in HD management.
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Affiliation(s)
- Ahmed Alshaikhsalama
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, United States
| | - Holden Archer
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, United States
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75235, United States
| | - Richard Ljuhar
- Department of Radiology, Image Biopsy, Vienna 1190, Austria
| | - Joel E Wells
- Department of Orthopedic Surgery, Baylor Scott and White, Dallas, TX 75235, United States
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75235, United States
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Harris MD, Thapa S, Lieberman EG, Pascual-Garrido C, Abu-Amer W, Nepple JJ, Clohisy JC. Identifying Risk Factors for Disease Progression in Developmental Dysplasia of the Hip Using a Contralateral Hip Model. J Bone Joint Surg Am 2024; 106:2322-2329. [PMID: 39692714 DOI: 10.2106/jbjs.24.00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) can cause pain and premature osteoarthritis. The risk factors and timing for disease progression in adolescents and young adults have not been fully defined. This study aimed to determine the prevalence of and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on a dysplastic hip. METHODS Patients undergoing unilateral PAO for DDH were followed for at least 2 years and categorized into contralateral pain and no-pain groups and contralateral surgery and no-surgery groups. Pain was defined with the modified Harris hip score. Univariate analysis tested group differences in demographics, radiographic measures, and range of motion. Kaplan-Meier survival analysis was used to assess pain development and surgery in the contralateral hip over time. Multivariable regression identified risk factors for contralateral pain and surgery. Contralateral pain and surgery predictors were secondarily assessed after categorization of the contralateral hips as dysplastic, borderline, and non-dysplastic and in subgroups based on the lateral center-edge angle (LCEA) and acetabular inclination (AI) in 5° increments. RESULTS One hundred and eighty-four patients were followed for a mean of 4.6 ± 1.6 years (range, 2.0 to 8.8 years), during which 51% (93) reported contralateral hip pain and 33% (60) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% with contralateral pain development as the end point and 66% with contralateral surgery as the end point. Painful hips exhibited more severe dysplasia compared with no-pain hips (LCEA = 16.5° versus 20.3°, p < 0.001; AI = 13.2° versus 10.0°, p < 0.001). AI was the sole predictor of pain, with every 1° increase in the AI raising the risk by 11%. Surgically treated hips also had more severe dysplasia (LCEA = 14.9° versus 20.0°, p < 0.001; AI = 14.7° versus 10.2°, p < 0.001) and were in younger patients (21.6 versus 24.1 years, p = 0.022). AI and a maximum alpha angle of ≥55° were predictors of contralateral surgery. CONCLUSIONS At 5 years after hip PAO, approximately 50% of contralateral hips will have pain and approximately 35% can be expected to need surgery. More severe dysplasia, based on the LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael D Harris
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Susan Thapa
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Elizabeth G Lieberman
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Wahid Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Sunil Kumar KH, Van Damme F, Van den Borr I, Khanduja V, Audenaert E, Malviya A. Understanding recurrent groin pain following periacetabular osteotomy: assessment of psoas tendon mechanics using discrete element analysis. J Hip Preserv Surg 2024; 11:243-250. [PMID: 39839561 PMCID: PMC11744472 DOI: 10.1093/jhps/hnae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/18/2024] [Accepted: 06/05/2024] [Indexed: 01/23/2025] Open
Abstract
Recurrent groin pain following periacetabular osteotomy (PAO) is a challenging problem. The purpose of our study was to evaluate the position and dynamics of the psoas tendon as a potential cause for recurrent groin pain following PAO. A total of 386 PAO procedures, performed between January 2013 and January 2020, were identified from a single surgeon series. Thirteen patients (18 hips) had a psoas tendinopathy, as confirmed with relief of symptoms following a diagnostic injection into the psoas tendon. All patients underwent computed tomography (CT) scans pre- and post-operatively. The data from CT scan was used to manually segment bony structures and create 3D models using Mimics software (Materialise NV). A validated discrete element analysis model using rigid body springs was used to predict psoas tendon movement during hip circumduction and walking. The distance of the iliopsoas tendon to any bony abnormality was calculated. All computational analyses were performed using MATLAB software. Thirteen hips (13/18) showed bony malformations (spurs, hypertrophic callus or delayed union and malunion) secondary to callus at the superior pubic ramus. The mean minimal distance of the iliopsoas tendon to osteotomy site was found to be 13.73 mm (σ = 3.09) for spurs, 10.99 mm (σ = 2.85) for hypertrophic callus and 11.91 mm (σ = 2.55) for canyon type. In normal bony healing, the mean minimal distance was 18.55 mm (σ = 4.11). Using a validated computational modelling technique, this study has demonstrated three different types of malformation around the superior pubic osteotomy site, which are associated with psoas impingement. In all of the cases, the minimal distance of the iliopsoas tendon to the osteotomy site was reduced by 59-74%, as compared with the normal anatomy.
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Affiliation(s)
- Karadi H Sunil Kumar
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - Floris Van Damme
- UZ Gent, University of Ghent, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Ide Van den Borr
- UZ Gent, University of Ghent, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Vikas Khanduja
- Addenbrookes—Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 0QQ, UK
| | | | - Ajay Malviya
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington, UK
- Newcastle University, Newcastle upon Tyne NE1 7RU UK
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Clohisy JC, Nepple JJ, Beaulé PE, Zaltz I, Millis M, Sierra RJ, Kim YJ, Sucato D, Sink E. Development and implementation of a roadmap for improving quality of care in prearthritic hip disease: A journey over 20 years. J Orthop Res 2024; 42:2362-2372. [PMID: 39180284 DOI: 10.1002/jor.25953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/24/2024] [Indexed: 08/26/2024]
Abstract
The understanding and treatment of prearthritic hip disease has evolved remarkably over the past 20 years. The principal investigator and the multicenter Academic Network of Conservational Hip Outcomes Research (ANCHOR) group have had a key role in improving the quality of care for these patients suffering from the three most common prearthritic conditions: femoroacetabular impingement, developmental dysplasia of the hip, and residual Legg-Calve-Perthes Disease. We aim to demonstrate that based on the six quality of care dimensions as defined by Donabedian, our 20-year academic journey has markedly improved the quality of care for young patients with prearthritic hip disease.
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Affiliation(s)
- John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul E Beaulé
- University of Ottawa, Ottawa Research Institute, Ontario, Ottawa, Canada
| | - Ira Zaltz
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Millis
- Boston's Children Hospital-Harvard, Boston, Massachusetts, USA
| | | | - Young-Jo Kim
- Boston's Children Hospital-Harvard, Boston, Massachusetts, USA
| | | | - Ernest Sink
- Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Evans EM, Palmer S, Gambling T, Sparkes V, Allen D. Development of an aid to detect adults acetabular hip dysplasia (the ALPHA alert): A mixed methods study. Musculoskelet Sci Pract 2024; 73:103157. [PMID: 39111210 DOI: 10.1016/j.msksp.2024.103157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/16/2024] [Accepted: 07/31/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVES To identify the signs and symptoms that people living with acetabular hip dysplasia (AHD) describe and to provide an aid for translating the findings into practice. METHODS A three-phased mixed methods study. Phase 1 employed an open-question online survey that enabled people with AHD (aged ≥16 years) to describe features associated with their condition. Responses were thematically analysed. A Phase 2 survey used these themes to establish how common those features were. Phase 3 created a mnemonic that prompts clinicians to suspect AHD. RESULTS Ninety-eight respondents completed Phase 1 and sixty-two completed Phase 2. From the responses, five themes were identified: Demographic and Diagnostic Profile; Characteristics of Posture and Gait; Pain; Childhood Hip and Family History; and Hip Joint Characteristics. Within these themes, 19 common signs and symptoms were reported, represented by the ALPHA mnemonic. ALPHA describes a young age at onset of problems (Age), a limp (Limp), progressing pain (Pain), a history of childhood and family hip anomalies (History) as well as hip joint hypermobility and instability (Articulation). CONCLUSION The findings extend current understanding of AHD indicators. ALPHA alerts clinicians to suspect a diagnosis of AHD. ALPHA may facilitate timelier referral of patients for diagnostic X-Ray and appropriate treatment. Future studies should evaluate its clinical utility.
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Affiliation(s)
| | - Shea Palmer
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Tina Gambling
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Valerie Sparkes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Harris JD, Hinojosa M, Williams JM, Stepke K, DuMont G. The critical importance of recognition, evaluation, and management of mental health on outcomes following hip arthroscopy - A synthetic narrative review: Current concepts. J ISAKOS 2024; 9:100299. [PMID: 39059584 DOI: 10.1016/j.jisako.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024]
Abstract
Mental health and wellness influence patients with hip pain and dysfunction secondary to Femoroacetabular Impingement Syndrome, acetabular dysplasia, and labral injury. Disorders of mental wellness may impact hip preservation surgery patients both before and after surgery. Major depression and generalized anxiety are the two most common diagnoses that affect hip preservation surgery patients. There are dozens of unique questionnaires that can subjectively and objectively characterize the mental health of patients with hip pain. Pain threshold and pain tolerance are two issues that must be recognized to optimally predict treatment outcome in an informed consent shared decision-making discussion. Patient expectations may also significantly influence preoperative symptoms and postoperative outcome. Pain threshold, pain tolerance, and patient expectations are entities traditionally viewed as qualitative and unmeasurable. However, many valid and reliable methods exist to quantitatively assess these patient-specific variables. Recent original research and synthetic review publications have consistently concluded similar findings: patients with disorders of mental wellness generally have lower preoperative patient-reported outcome scores, do improve following surgery, albeit to a lesser magnitude than non-mental disorder patients, and ultimately have lower postoperative scores at their final follow. As with most orthopaedic surgery literature, the investigation of mental health and hip preservation is primarily via retrospective level four evidence with small numbers of patients from a single centre and single surgeon at short-term follow-up. Although hip preservation surgeons are orthopaedic surgeons by training and practice, they must be able to recognize mental wellness disorders and either treat or refer when suspected or identified.
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Affiliation(s)
- Joshua D Harris
- Houston Methodist Hospital, Department of Sports Medicine and Orthopedics, 6565 Fannin Street, Houston, TX, 77030, USA.
| | - Miriam Hinojosa
- Houston Methodist Hospital, Department of Sports Medicine and Orthopedics, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Julia M Williams
- Houston Methodist Hospital, Department of Sports Medicine and Orthopedics, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Katherine Stepke
- Houston Methodist Hospital, Department of Sports Medicine and Orthopedics, 6565 Fannin Street, Houston, TX, 77030, USA
| | - Guillaume DuMont
- Lexington Orthopaedics and Sports Medicine, 3016 Longtown Commons Drive, Suite 200, Columbia, SC 29229, USA
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11
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Harris MD, Gaffney BM, Clohisy JC, Pascual-Garrido C. Femurs in patients with hip dysplasia have fundamental shape differences compared with cam femoroacetabular impingement. J Hip Preserv Surg 2024; 11:132-139. [PMID: 39070210 PMCID: PMC11272640 DOI: 10.1093/jhps/hnae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 07/30/2024] Open
Abstract
Femoral deformities are common in developmental dysplasia of the hip (DDH), but decisions about how to treat them are not standardized. Of interest are deformities that may be akin to cam femoroacetabular impingement (FAI). We used three-dimensional and two-dimensional measures to clarify the similarities and differences in proximal femur shape variation among female patients with DDH (n = 68) or cam FAI (n = 60). Three-dimensional measures included femoral head asphericity, as well as shape variation using statistical shape modeling and principal component analysis (PCA). Two-dimensional measures included the α-angle, head-neck offset (HNO) and the neck-shaft angle (NSA). Significant shape variations were captured in the first five PCA modes, with the greatest shared variation between groups being the length from the lesser trochanter to the femoral head and greater trochanter height. Variations unique to DDH were irregularities at different areas of the femoral head, but not at the lateral femoral head-neck junction where variation was strong in FAI. The FAI group also had unique variations in greater trochanter shape. DDH femoral heads were less spherical, as indicated by larger sphere-fitting errors (P < 0.001). Radiographically, the DDH group had significantly smaller α-angles (P < 0.001), larger head-neck offsets (P = 0.02) and larger NSAs (P < 0.001). Both the articular and extra-articular regions of the proximal femur have distinct shape features in DDH and cam FAI that can uniquely affect the biomechanics of each disorder. Accordingly, approaches to addressing each disorder should be unique.
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Affiliation(s)
- Michael D Harris
- Program in Physical Therapy, Department of Orthopaedic Surgery, Washington University School of Medicine, 4444 Forest Park Ave, St Louis, MO 63108, USA
| | - Brecca M.M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, 1200 Larimer St North Classroom Bldg, Denver, CO 80204, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, USA
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12
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Alrashdi N, Motl R, Aguiar E, Lein Jr D, Perumean-Chaney S, Ryan M, Ithurburn M. Pre- and Post-Operative Pain Intensity and Physical Activity Levels in Individuals with Acetabular Dysplasia Undergoing Periacetabular Osteotomy: A Prospective Cohort Study. Int J Sports Phys Ther 2024; 19:692-703. [PMID: 38835978 PMCID: PMC11144661 DOI: 10.26603/001c.117403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/12/2024] [Indexed: 06/06/2024] Open
Abstract
Background Acetabular dysplasia (AD) causes pain, limited function, and development of early hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical treatment for AD that aims to reposition the acetabulum to reduce pain and improve function. Purpose To examine pain recovery and physical activity (PA) before and during the six months after PAO. Study Design Case series, prospective. Methods Individuals with AD scheduled for PAO were enrolled. Pain intensity was evaluated before PAO and at one week and one, three, and six months following PAO. PA levels was evaluated before and six months following PAO using accelerometers (time spent in sedentary behavior, light PA, moderate-to-vigorous PA [MVPA], and daily steps) and the International Physical Activity Questionnaire (IPAQ; time spent in walking and in MVPA). Pain improvements was examined over time following PAO using a repeated-measures one-way ANOVA as well as improvements in PA levels before and six months after PAO using paired-sample t tests. In addition, time spent in MVPA was qualitatively summarized at each time point (before and six months after PAO) measured by both the accelerometers and IPAQ. Results Out of 49 screened participants, 28 were enrolled, and 23 individuals (22 females; age=23.1±7.9 years) completed both study visits. Compared to pre-PAO pain, participants reported significant improvements in pain at one month and onward following PAO (p\<0.011). However, PA levels at six months following PAO did not differ from pre-PAO PA levels (p>0.05). Qualitatively, participants reported spending more time in MVPA recorded by the IPAQ (pre-PAO=73.3±150.2 mins/day; six-months after PAO=121.2±192.2 mins/day), compared with MVPA recorded by accelerometers (pre-PAO=22.6±25.2 mins/day; six-months after PAO=25.0±21.4 mins/day). Conclusions Individuals with AD reported significant pain reduction at one month and up to six months after PAO, but PA levels did not change six months after PAO compared to baseline testing. Future studies should consider examining longitudinal pain recovery and PA improvements over longer periods of time with larger samples of individuals with AD undergoing PAO and identifying modifiable factors to minimize pain and increase PA participation. Level of Evidence III.
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Affiliation(s)
- Naif Alrashdi
- 1. Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Kingdom of Saudi ArabiaMajmaah University
| | - Robert Motl
- KinesiologyUniversity of Illinois at Chicago
| | | | | | | | - Michael Ryan
- Hip CenterAndrews Institute for Orthopaedics & Sports Medicine
| | - Matthew Ithurburn
- American Sports Medicine InstituteAmerican Sports Medicine Institute
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13
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Thirumaran AJ, Murphy NJ, Fu K, Hunter DJ. Femoroacetabular impingement - What the rheumatologist needs to know. Best Pract Res Clin Rheumatol 2024; 38:101932. [PMID: 38336510 DOI: 10.1016/j.berh.2024.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Femoroacetabular impingement (FAI) syndrome is a common cause of hip and groin pain in young individuals. FAI syndrome is a triad of signs, symptoms, and imaging findings. Necessary but not sufficient for the diagnosis of FAI syndrome is the presence of cam and/or pincer morphology of the hip. However, pathological thresholds for cam and pincer morphologies are not well-established. Management of FAI syndrome is typically through either physiotherapist-led therapy or surgical intervention. Physiotherapist-led management involves exercises aimed to optimise movement patterns of the hip and pelvis to prevent impingement from occurring, activity modification and analgesia, whereas surgical management involves arthroscopic resection of the cam/pincer morphology and treatment of concomitant soft tissue pathologies such as labral tears, cartilage lesions or ligamentum teres tears. Careful consideration of intervention is required given that FAI syndrome may predispose those affected to developing future osteoarthritis of the hip. In most clinical trials, hip arthroscopy has been found to provide greater improvement in patient-reported outcomes in the short-term compared to physiotherapy, however it is unknown whether this is sustained in the long-term or affects the future development of hip osteoarthritis.
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Affiliation(s)
- Aricia Jieqi Thirumaran
- Nepean Hospital, Kingswood, NSW, 2747, Australia; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Nicholas J Murphy
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; University of Newcastle and Department of Orthopaedic Surgery, John Hunter Hospital, New Lambton, NSW, 2305, Australia
| | - Kai Fu
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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14
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Grosklos M, Perry J, Elwood M, Jochimsen K, Di Stasi S. Dynamic joint stiffness in individuals with femoroacetabular impingement syndrome pre- and post-hip arthroscopy. Clin Biomech (Bristol, Avon) 2024; 112:106187. [PMID: 38280259 DOI: 10.1016/j.clinbiomech.2024.106187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Patients with hip-related pain often fail to return to their desired level of activity following hip arthroscopy. Lasting biomechanics alterations may be one potential explanation. Dynamic joint stiffness assesses the mechanistic controls of the lower limb during high impact movements, and thus, may provide valuable clinical targets to improving movement and optimizing return to activity after surgery. METHODS Twenty-five participants (13 females) with hip-related pain underwent 3D motion capture during a drop jump task before surgery and six months post-operatively. Nineteen healthy controls (9 females) were collected for comparison. Sagittal plane dynamic joint stiffness was calculated during the initial landing phase. Baseline and 6-month dynamic joint stiffness data were compared 1) between males and females with hip-related pain and 2) between individuals with hip-related pain and controls using Wilcoxon Signed-Rank and Mann Whitney U tests. Sexes were analyzed separately. FINDINGS From baseline to 6 months post-operatively, females with hip-related pain demonstrated decreased dynamic ankle stiffness (2.26 Nm/deg. [0.61] to 1.84 Nm/deg. [0.43]) (p = .005) and males with hip-related pain demonstrated increased dynamic hip stiffness (2.73 [0.90] to 3.88 [1.73]) (p = .013). There were no differences in dynamic stiffness at any joint between individuals with hip-related pain at either timepoint when compared to controls (p ≥ .099). INTERPRETATION Females and males with hip-related pain may demonstrate unique changes in dynamic joint stiffness after surgery, indicating return to activity may follow different trajectories for each sex. Additional work should examine the relationship between hip joint stiffness and treatment outcomes and identify additional movement-related rehabilitation targets.
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Affiliation(s)
- Madeline Grosklos
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Department of Mechanical Engineering, The Ohio State University, 201 W 19th Ave, Columbus, OH 43210, USA.
| | - Megan Elwood
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
| | - Kate Jochimsen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
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15
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Woodward RM, Lightfoot NJ, Vesey RM, van Dijck SA, Munro JT, Boyle MJ. Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports. J Med Imaging Radiat Oncol 2024; 68:26-32. [PMID: 37654031 DOI: 10.1111/1754-9485.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Timely recognition of dysplastic hip morphology is critical to facilitate appropriate management before significant joint damage has developed. It is likely that radiologist under reporting contributes to delays in diagnosis. This study aimed to assess how often adult hip dysplasia goes undetected in radiological reports and to identify clinical and radiological variables that impact the likelihood of detection of dysplasia by radiologists. METHODS Referral details and radiology reports of patients who underwent periacetabular osteotomy by a single surgeon for symptomatic hip dysplasia between 1 January 2016 and 30 June 2020 were reviewed. Four assessors measured the lateral centre edge angle from the pelvic radiograph performed at time of referral. Film quality and other radiographic parameters were also assessed. RESULTS Sixty-eight patients were included, 84% were female and the median age was 28.1 years. Dysplasia was not documented in the radiology report in 49% of cases. Dysplasia was more likely to be reported with no history of injury, an aspherical femoral head, lower lateral centre edge angle, higher acetabular index, increased femoral head shaft angle, higher femoro-epiphyseal acetabular roof index, or if there was disruption of Shenton's line, with the first three variables being independent predictors of radiologist detection. CONCLUSION Hip dysplasia should be considered in all adolescents/young adults presenting with hip pain. Causes of radiologist under reporting are likely multifactorial. Clinical information can cause cognitive biases and result in selective looking. A systematic approach to pelvis radiographs should include assessment of acetabular coverage and active search for evidence of femoral head migration.
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Affiliation(s)
- Rebecca M Woodward
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland Radiology Group, Auckland, New Zealand
| | - Nicholas J Lightfoot
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Pain Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Renuka M Vesey
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stephanie A van Dijck
- Department of Orthopaedic Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Jacob T Munro
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Matthew J Boyle
- Department of Orthopaedic Surgery, Starship Children's Hospital, Auckland, New Zealand
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O’Brien MJM, Semciw AI, Mechlenburg I, Tønning LCU, Stewart CJW, Kemp JL. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis. Hip Int 2024; 34:96-114. [PMID: 37306161 PMCID: PMC10787396 DOI: 10.1177/11207000231179610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. PURPOSE In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. METHODS A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. RESULTS From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. CONCLUSIONS Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. REGISTRATION PROSPERO (CRD42020144748).
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Affiliation(s)
- Michael JM O’Brien
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- MOG Sports Medicine, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa CU Tønning
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Chris JW Stewart
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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17
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Everett BP, Lin J, Gudmundsson P, Owhonda R, Nakonezny PA, Middleton E, Chhabra A, Wells JE. The Relationship Between Postoperative Patient-Reported Psychological Outcomes and Preoperative Pain Characteristics in Patients Who Underwent Periacetabular Osteotomy. Orthopedics 2024; 47:28-33. [PMID: 37126840 DOI: 10.3928/01477447-20230426-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study sought to investigate the relationship between multiple preoperative characteristics of pain (maximum pain severity location, the presence of pain in certain locations, the highest level of pain, and the number of pain locations) and psychological outcome measures as reported by patients. Fifty-four hips (50 patients) that underwent periacetabular osteotomy to treat acetabular dysplasia between February 2017 and July 2020 were reviewed using the Depression, Anxiety, and Stress Scale-21 (DASS21), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS), radiographic analysis, and questionnaires concerning pain severity/location. Twenty-six hips had their worst pain in the groin, whereas 28 hips had greater or equal levels of pain at another location. There was no significant difference between these two locations on any of the postoperative psychological outcomes (HADS, P=.53; DASS21, P=.85; PCS, P=.97). Additionally, there was not a significant relationship between pain in any location other than the groin and any postoperative psychological outcomes (P≥.08). Finally, the highest level of preoperative pain and the number of locations of pain demonstrated no significant relationship with postoperative psychological outcomes (maximum severity: HADS, P=.28; DASS21, P=.49; PCS, P=.57; number of pain locations: HADS, P=.47; DASS21, P=.60; PCS, P=.35). Variance in preoperative pain location, severity, and number of pain locations seemingly does not result in any significant effect on postoperative psychological outcomes. Thus, a large range of patients with acetabular dysplasia may experience similar, favorable psychological outcomes from treatment with periacetabular osteotomy notwithstanding the characteristics of preoperative pain. [Orthopedics. 2024;47(1):28-33.].
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18
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Disantis AE, Martin RL, Enseki K, Spaid V, McClincy M. Non-Operative Rehabilitation Principles for Use in Individuals with Acetabular Dysplasia: A North American Based Delphi Study. Int J Sports Phys Ther 2023; 18:1331-1345. [PMID: 38050551 PMCID: PMC10693488 DOI: 10.26603/001c.89265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/24/2023] [Indexed: 12/06/2023] Open
Abstract
Background Acetabular dysplasia (AD) is defined as a structurally deficient acetabulum and is a well-recognized cause of hip pain in young adults. While treatment of severe AD with a periacetabular osteotomy has demonstrated good long-term outcomes, a trial of non-operative management is often recommended in this population. This may be especially true in patients with milder deformities. Currently, there is a paucity of research pertaining to non-operative management of individuals with AD. Purpose To present expert-driven non-operative rehabilitation guidelines for use in individuals with AD. Study Design Delphi study. Methods A panel of 15 physiotherapists from North America who were identified as experts in non-operative rehabilitation of individuals with AD by a high-volume hip preservation surgeon participated in this Delphi study. Panelists were presented with 16 questions regarding evaluation and treatment principles of individuals with AD. A three-step Delphi method was utilized to establish consensus on non-operative rehabilitation principles for individuals presenting with AD. Results Total (100%) participation was achieved for all three survey rounds. Consensus, defined a piori as > 75%, was reached for 16/16 questions regarding evaluation principles, activity modifications, appropriate therapeutic exercise progression, return to activity/sport criteria, and indications for physician referral. Conclusion This North American based Delphi study presents expert-based consensus on non-operative rehabilitation principles for use in individuals with AD. Establishing guidelines for non-operative management in this population will help reduce practice variation and is the first step in stratifying individuals who would benefit from non-operative management. Future research should focus on patient-reported outcomes and rate of subsequent surgical intervention to determine the success of the guidelines reported in this study. Level of Evidence Level V.
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Affiliation(s)
- Ashley E Disantis
- Adolescent and Young Adult Hip Preservation Program UPMC Childrens Hospital of Pittsburgh
- Rangos School of Health Sciences, Department of Physical Therapy Duquesne University
| | - RobRoy L Martin
- Rangos School of Health Sciences, Department of Physical Therapy Duquesne University
| | - Keelan Enseki
- UPMC Freddie Fu Center for Sports Medicine UPMC Rehabilitation Institute
| | - Victoria Spaid
- Department of Orthopaedic Surgery UPMC Children's Hospital of Pittsburgh
| | - Michael McClincy
- Adolescent and Young Adult Hip Preservation Program UPMC Children's Hospital of Pittsburgh
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19
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O'Brien MJM, Heerey J, Semciw AI, Mechlenburg I, Jacobsen JS, King MG, Scholes MJ, Lawrenson PR, Crossley K, Agricola R, Souza RB, Kemp JL. Does hip muscle strength and functional performance differ between football players with and without hip dysplasia? Phys Ther Sport 2023; 64:1-7. [PMID: 37598519 DOI: 10.1016/j.ptsp.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To compare hip muscle strength and functional performance in football players with and without hip dysplasia and investigate if the relationships were modified by sex. DESIGN Cross-sectional study. METHODS This study compared football players with hip dysplasia (HD group) and without hip dysplasia (control group). Hip muscle strength (Nm/kg) and functional task performance were assessed in both groups. Linear regression with generalized estimating equations were used to assess differences between groups. Sex was assessed as a potential effect modifier. RESULTS 101 football players were included (HD group, n = 50, control group, n = 51). There was no difference in hip muscle strength or functional performance between the HD group and the control group. Results ranged from hip extension strength (Estimate -0.13.95%CI: 0.29 to 0.02, P = 0.087) to hip external rotation strength (Estimate 0.00.95%CI: 0.05 to 0.05, P = 0.918). No relationships were modified by sex or age. CONCLUSIONS Similar levels of hip muscle strength and functional performance were found in active football players with and without hip dysplasia. These findings differ from other studies. This may be due to our cohort having less advanced hip dysplasia than the surgical populations that have been previously investigated, or due to a beneficial effect of football participation on muscle strength and functional performance in people with hip dysplasia.
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Affiliation(s)
- Michael J M O'Brien
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia. m.o'
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Ivan Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julie S Jacobsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark; Research Unit for General Practice, Aarhus, Denmark
| | - Matthew G King
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia
| | - Mark J Scholes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Kay Crossley
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Rintje Agricola
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, Rotterdam, the Netherlands
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA
| | - Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
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Thummala A, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The Relationship Between Pelvic Tilt and Clinical Outcomes After Hip Preservation Surgery in Femoroacetabular Impingement Syndrome and Hip Dysplasia. Orthopedics 2023; 46:e341-e346. [PMID: 37052593 DOI: 10.3928/01477447-20230407-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Pelvic tilt is thought to be a compensatory mechanism in hip pathology, specifically in patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. This study investigated the relationship between preoperative pelvic tilt and postoperative outcomes in patients undergoing hip preservation surgery for FAIS or hip dysplasia. We reviewed a prospective hip preservation database for demographic, radiographic, and outcome data for 89 patients who underwent hip preservation surgery with a primary diagnosis of FAIS or dysplasia from 2016 to 2020. Pelvic tilt was assessed on the standing anteroposterior radiograph with the pubic symphysis to sacroiliac joint (PS-SI) distance measurement. The International Hip Outcome Tool 12 (iHOT-12), Hip Outcome Score, Harris Hip Score, UCLA activity score, and European Quality of Life-Visual Analog Scale were used to assess hip function and pain preoperatively and postoperatively. The mean pelvic tilt (PS-SI distance) was 86.4±18.3 mm for the FAIS group and 96.2±15.1 mm for the dysplasia group. The statistical analysis demonstrated a positive relationship between pelvic tilt and change in iHOT-12 score (rs=0.262, P=.019) for all 89 patients with hip pathology and, separately, a trend toward significance for the 42 patients with FAIS (rs=0.330, P=.056). No other significant relationships were observed. The improvement in iHOT-12 score was greater for patients with more anterior tilt and less for patients with posterior pelvic tilt, regardless of underlying hip etiology. These results provide intriguing insights into an initial investigation on pelvic tilt in patients undergoing hip preservation surgery. Further investigation is necessary to assess pelvic tilt preoperatively and postoperatively, spinal parameters, and longer-term outcomes. [Orthopedics. 2023;46(6):e341-e346.].
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21
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Atadja LA, Chhabra A, Kohli A, Lin J, Gudmundsson P, Owhonda R, Middleton E, Wells JE. Duration of Symptoms Does Not Significantly Influence Short-term Outcomes for Patients Undergoing Periacetabular Osteotomy. Orthopedics 2023; 46:365-372. [PMID: 37018619 DOI: 10.3928/01477447-20230329-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Factors influencing the clinical outcomes after periacetabular osteotomy (PAO) have not been well explored. This study evaluated the influence of symptom duration in developmental dysplasia of the hip on short-term patient-reported outcomes after PAO. A retrospective review of prospectively collected data identified PAOs performed on 139 patients. Sixty-five patients were then stratified into two groups based on preoperative symptom duration: 2 years or less (n=22) vs more than 2 years (n=43). We compared the results of hip-specific patient-reported outcome surveys collected preoperatively and postoperatively. When comparing the two groups, we found no significant differences in clinical outcome scores except for the UCLA Activity Scale. The shorter duration group achieved improvement 6 months postoperatively on the visual analog scale average pain score (from 4.5 to 2.167; P=.0017), International Hip Outcome Tool-12 (from 42.95 to 59.19; P=.0176), and Harris Hip Score (from 53.88 to 69.88; P=.049). The longer duration group also achieved postoperative improvement across multiple surveys. Nevertheless, a multivariate analysis controlling for age, sex, and body mass index and found that symptom duration did not independently affect the change in clinical outcomes. Although PAO leads to improvements in functional status and pain, preoperative symptom duration does not significantly affect these clinical outcomes. [Orthopedics. 2023;46(6):365-372.].
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22
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Albar A, Sher AC, Rosenfeld S, Ditzler M, Kraus S, Crowe J, Sangi-Haghpeykar H, Kan JH. Improved Identification of Adolescent Hip Dysplasia Using a Screening Method Based on Lateral Center Edge Angle Measurements. Acad Radiol 2023; 30:2140-2146. [PMID: 37393178 DOI: 10.1016/j.acra.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND In addition to the clinical exam, several quantitative measurement tools are performed on pelvic radiographs in the assessment of adolescent hip dysplasia at most dedicated pediatric hip preservation clinics, with the most commonly used measurement called the lateral center edge angle (LCEA). However, most pediatric radiologists do not use these quantitative measuring tools and instead make the diagnosis of adolescent hip dysplasia based on subjective review. OBJECTIVE The purpose of this study is to determine the additive value of a measurement-based diagnosis of adolescent hip dysplasia using LCEA versus subjective radiographic interpretation by pediatric radiologists. METHODS A review of pelvic radiographs for the binomial diagnosis of hip dysplasia was performed by four pediatric radiologists (two general, two musculoskeletal). The review included 97 pelvic AP radiographs (mean age 14.4 years [range 10-20 years], 81% female) for a total of 194 hips (58 cases of adolescent hip dysplasia and 136 normal) all of whom were evaluated in a tertiary care pediatric subspecialty hip preservation clinic. Subjective radiographic interpretation of each hip for a binomial diagnosis of hip dysplasia was performed. 2 weeks later and without knowledge of the subjective radiographic interpretation results, the same review was performed with LCEA measurement and a diagnosis of hip dysplasia made when LCEA angles were under 18 degrees. A comparison of sensitivity/specificity between methods per reader was conducted. A comparison of accuracy between methods for all readers combined was performed. RESULTS For all four reviewers, the sensitivity of subjective versus LCEA measurement-based diagnosis of hip dysplasia was 54-67% (average 58%) versus 64-72% (average 67%), respectively, and specificity was 87-95% (average 90%) versus 89-94% (average 92%), respectively. All four readers demonstrated an intra-reader trend for improvement in the diagnosis of adolescent hip dysplasia after the addition of LCEA measurements but was only statistically significant in one of the four readers. The combined accuracy of all four readers for subjective and LCEA measurement-based interpretation was 81% and 85%, respectively with p = 0.006. CONCLUSION Compared with subjective interpretation, LCEA measurements demonstrate increased diagnostic accuracy amongst pediatric radiologists for the correct diagnosis of adolescent hip dysplasia.
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Affiliation(s)
- Abeer Albar
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (A.A., A.C.S., M.D., S.K., J.C.); Department of Radiology, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia (A.A.).
| | - Andrew C Sher
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (A.A., A.C.S., M.D., S.K., J.C.)
| | - Scott Rosenfeld
- Department of Orthopedic Surgery, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (S.R.)
| | - Matt Ditzler
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (A.A., A.C.S., M.D., S.K., J.C.)
| | - Steve Kraus
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (A.A., A.C.S., M.D., S.K., J.C.)
| | - James Crowe
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (A.A., A.C.S., M.D., S.K., J.C.)
| | | | - J Herman Kan
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (A.A., A.C.S., M.D., S.K., J.C.)
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23
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Grosklos M, Lewis CL, Ceballos E, Perry J, Di Stasi S. Females with hip-related pain demonstrate reduced kinetics at the hip and ankle during terminal stance of gait. Gait Posture 2023; 105:99-103. [PMID: 37515892 PMCID: PMC10527984 DOI: 10.1016/j.gaitpost.2023.07.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Individuals with hip-related pain (HRP) commonly report pain with walking and demonstrate altered movement patterns compared to healthy controls (HCs). Individuals with HRP may attempt to reduce pain during walking by decreasing kinetics and joint forces at the hip through increased use of the ankle during pushoff. RESEARCH QUESTION Do individuals with HRP have increased kinetics at the ankle and decreased kinetics at the hip during pushoff in gait compared to HCs, and do kinetic patterns differ between males and females with HRP? METHODS This retrospective observational study included 42 individuals with HRP and 20 HCs. Participants completed overground gait trials at their self-selected speed while kinematics and kinetics were recorded through a motion capture system and force plates. Peak internal hip and ankle moments and hip flexion and ankle plantarflexion angular impulse during terminal stance were used in general estimating equations for comparison of group by limb interactions for males and females separately, as well as a comparison of males and females within the HRP group. RESULTS Females with HRP demonstrated reduced hip flexion impulse on their involved limb (.070 Nm*s/kg*m) compared to female HCs (.083Nm*s/kg*m; p = .032), as well as reduced peak ankle plantarflexion moment (-.94Nm/kg*m) compared to their contralateral limb (-.99Nm/kg*m) and the involved limb of HRP males (-1.00Nm/kg*m) (p ≤ .007). There were no between-limb or between-group differences in hip or ankle peak moments or impulses in males. SIGNIFICANCE Females with HRP show decreased kinetics at both the hip and ankle; these patterns were not identified in males. Future investigations should examine whether increasing ankle kinetics during pushoff reduces pain at the hip, as this may be a valuable clinical treatment strategy.
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Affiliation(s)
- Madeline Grosklos
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA; Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
| | - Cara L Lewis
- Department of Physical Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA 02215, USA
| | - Elizabeth Ceballos
- The Ohio State University Wexner Medical Center Division of Sport Physical Therapy, 2835 Fred Taylor Dr, Columbus, OH 43202, USA
| | - Jennifer Perry
- Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Department of Mechanical Engineering, The Ohio State University, 201 W. 19th Avenue, Columbus, OH 43210, USA
| | - Stephanie Di Stasi
- Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
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24
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Lin CR, Chou H, Luo CA, Chang SH. A Novel Technique for Autograft Preparation Using Patient-Specific Instrumentation (PSI) Assistance in Total Hip Arthroplasty in Developmental Dysplasia of Hip (DDH). J Pers Med 2023; 13:1331. [PMID: 37763099 PMCID: PMC10532815 DOI: 10.3390/jpm13091331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Due to the change in the structure of the proximal femur and acetabulum in patients with developmental dysplasia of the hip, total hip arthroplasty (THA) was difficult to perform for surgeons. To elevate the acetabular coverage rate, we developed a technique in the use of a patient-specific instrumentation (PSI) graft in patients with developmental dysplasia of hip (DDH) undergoing surgery. This study aims to evaluate the peri-operative outcomes of THA with PSI graft in patients with DDH. This study recruited 6 patients suffering from Crowe I DDH with secondary Grade IV osteoarthritis. All the patients underwent THA with PSI graft performed by a well-experienced surgeon. Perioperative outcomes included surgical procedures, blood loss during operation, the volume of blood transfusion, length of hospitalization, complications, and the mean difference in hemoglobin levels before and after surgery. All the outcomes analyzed were assessed by mean and standard deviation. The average duration of the surgical procedure was found to be 221.17 min, with an SD of 19.65 min. The mean blood loss during the operation was 733.33 mL, with an SD of 355.90 mL. The mean length of hospital stay was calculated to be 6 days, with an SD of 0.89 days. Furthermore, the mean difference between the pre- and postoperative hemoglobin levels was 2.15, with an SD of 0.99. A total of three patients received 2 units of leukocyte-poor red blood cells (LPR) as an accepted blood transfusion. There were no reported complications observed during the admission and one month after the operation. This study reported the peri-operative outcomes in the patients with DDH who underwent THA with PSI graft. We found that THA with PSI graft would provide a safe procedure without significant complications. We assumed that the PSI graft in THA may increase the coverage rate of the acetabulum, which may increase the graft union rates. Further cohort studies and randomized controlled trials were needed to confirm our findings.
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Affiliation(s)
- Chun-Ru Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan City 333423, Taiwan;
| | - Hsuan Chou
- School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan;
| | - Chu-An Luo
- Department of Precision Surgery Development, A Plus Biotechnology Co., Ltd., 6F, No. 23, Qiaohe Road, Zhonghe District, New Taipei City 23529, Taiwan;
| | - Shu-Hao Chang
- School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan;
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan
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25
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Andronic O, Germann C, Jud L, Zingg PO. Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia. Bone Joint J 2023; 105-B:735-742. [PMID: 37391200 DOI: 10.1302/0301-620x.105b7.bjj-2022-1058.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Aims This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD. Methods We identified 42 hips in 40 patients treated between January 2009 and January 2016 with BHD defined as a lateral centre-edge angle (LCEA) of ≥ 18° but < 25°. A minimum five-year follow-up was available. Patient-reported outcomes (PROMs) including Tegner score, subjective hip value (SHV), modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. The following morphological parameters were evaluated: LCEA, acetabular index (AI), α angle, Tönnis staging, acetabular retroversion, femoral version, femoroepiphyseal acetabular roof index (FEAR), iliocapsularis to rectus femoris ratio (IC/RF), and labral and ligamentum teres (LT) pathology. Results The mean follow-up was 96 months (67 to 139). The SHV, mHHS, WOMAC, and Tegner scores significantly improved (p < 0.001) at last follow-up. According to SHV and mHHS, there were three hips (7%) with poor results (SHV < 70), three (7%) with a fair score (70 to 79), eight (19%) with good results (80 to 89), and 28 (67%) who scored excellent (> 90) at the last follow-up. There were 11 subsequent operations: nine implant removals due to local irritation, one resection of postoperative heterotopic ossification, and one hip arthroscopy for intra-articular adhesions. No hips were converted to total hip arthroplasty at last follow-up. The presence of preoperative labral lesions or LT lesions did not influence any PROMs at last follow-up. From the three hips that had poor PROMs, two have developed severe osteoarthritis (> Tönnis II), presumably due to surgical overcorrection (postoperative AI < -10°). Conclusion PAO is reliable in treating BHD with favourable mid-term outcomes. Concomitant LT and labral lesions did not negatively influence outcomes in our cohort. Technical accuracy with avoidance of overcorrection is essential in achieving successful outcomes.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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26
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Muellner M, Ziegeler K, Diekhoff T, Haffer H, Schömig F, Leopold VJ, Pumberger M, Göhler F. Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia. Diagnostics (Basel) 2023; 13:diagnostics13101701. [PMID: 37238185 DOI: 10.3390/diagnostics13101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Osteitis condensans ilii (OCI) is a relatively rare benign disease of the lower anterior sacroiliac joint (SIJ) region that can cause symptoms such as low back pain (LBP), lateral hip pain and nonspecific hip or thigh pain. Its exact pathoetiology remains to be clarified. The aim of this study is to determine the prevalence of OCI in patients with symptomatic developmental dysplasia of the hip (DDH) undergoing periacetabular osteotomy (PAO) to identify potential clustering of OCI in a with altered biomechanics of hip and SIJs. METHODS A retrospective investigation of all patients who underwent periacetabular osteotomy in a tertiary reference hospital from January 2015 to December 2020. Clinical and demographic data were retrieved from the hospital's internal medical records. Radiographs and magnetic resonance images (MRIs) were reviewed for the presence of OCI. A t-test for independent variables was conducted to identify differences between patients with and without OCI. A binary logistic regression model was established to determine the influence of age, sex and body mass index (BMI) on the presence of OCI. RESULTS The final analysis included 306 patients (81% female). In 21.2% of the patients (f: 22.6%; m: 15.5%), OCI was present. BMI was significantly higher in patients with OCI (23.7 kg/m2 vs. 25.0 kg/m2; p = 0.044). Binary logistic regression revealed that a higher BMI increased the likelihood of sclerosis in typical osteitis condensans locations, OR = 1.104 (95%-CI [1.024, 1.191]), as did female sex, OR = 2.832 (95%-CI [1.091, 7.352]. CONCLUSIONS Our study revealed a considerably higher prevalence of OCI in patients with DDH than in the general population. Furthermore, BMI was shown to have an influence on the occurrence of OCI. These results support the theory that OCI is attributable to altered mechanical loading of the SIJs. Clinicians should be aware that OCI is common in patients with DDH and a potential cause of LBP, lateral hip pain and nonspecific hip or thigh pain.
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Affiliation(s)
- Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Vincent Justus Leopold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friedemann Göhler
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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27
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Orner CA, Haws BE, Reuter J, Kenney R, Cook PC, Giordano BD. Patient-Reported Outcomes are Similar in the First Two Years after Staged versus Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia. Arthroscopy 2023:S0749-8063(23)00197-4. [PMID: 36868528 DOI: 10.1016/j.arthro.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to compare early patient reported outcomes after staged versus combined hip arthroscopy and periacetabular osteotomy for hip dysplasia. METHODS A prospective database was retrospectively reviewed to identify patients that underwent combined or staged hip arthroscopy and PAO from 2012-2020. Patients were excluded if they were >40 years of age, had prior ipsilateral hip surgery, or did not have at least 12-24 month postoperative PRO data. PROs included the Hip Outcomes Score (HOS) Activities of Daily Living (ADL) and Sports Subscale (SS), Non-Arthritic Hip Score (NAHS), and the Modified Harris Hip Score (mHHS). Paired t-tests were used to compare preoperative to postoperative scores for both groups. Outcomes were compared using linear regression adjusted for baseline characteristics including age, obesity, cartilage damage, acetabular index, and procedure timing (early vs. late practice). RESULTS Sixty-two hips were included in this analysis (39 combined, 23 staged). The average length of follow up was similar between the combined and staged groups (20.8 vs. 19.6 months, p=0.192). Both groups reported significant improvements in PROs at final follow up compared to preoperative scores (p<0.05 for all). There were no significant differences in HOS-ADL, HOS-SS, NAHS, or mHHS scores between groups preoperatively or at 3, 6, or 12 months postoperatively (p>0.05 for all). There was no significant difference in PROs between the combined and staged groups at the final postoperative time point: HOS-ADL (84.5 vs. 84.3, p=0.77), HOS-SS (76.0 vs. 79.2, p=0.68), NAHS (82.2 vs. 84.5, p=0.79), mHHS (71.0 vs. 71.0, p=0.75) respectively. CONCLUSION Staged hip arthroscopy and PAO for hip dysplasia leads to similar PROs at 12-24 months compared to combined procedures. This suggests that with careful and informed patient selection, staging these procedures is an acceptable option for these patients and does not change early outcomes. LEVEL OF EVIDENCE Level III Retrospective Comparative.
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Affiliation(s)
- Caitlin A Orner
- Cedars Sinai Kerlan Jobe Institute, Department of Orthopaedics, 6801 Park Terrace, Suite 140, Los Angeles, CA 90045, U.S.A
| | - Brittany E Haws
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - John Reuter
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Raymond Kenney
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - P Christopher Cook
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Brian D Giordano
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
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28
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Jensen J, Graumann O, Overgaard S, Gerke O, Lundemann M, Haubro MH, Varnum C, Bak L, Rasmussen J, Olsen LB, Rasmussen BSB. A Deep Learning Algorithm for Radiographic Measurements of the Hip in Adults-A Reliability and Agreement Study. Diagnostics (Basel) 2022; 12:2597. [PMID: 36359441 PMCID: PMC9689405 DOI: 10.3390/diagnostics12112597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 08/04/2023] Open
Abstract
Hip dysplasia (HD) is a frequent cause of hip pain in skeletally mature patients and may lead to osteoarthritis (OA). An accurate and early diagnosis may postpone, reduce or even prevent the onset of OA and ultimately hip arthroplasty at a young age. The overall aim of this study was to assess the reliability of an algorithm, designed to read pelvic anterior-posterior (AP) radiographs and to estimate the agreement between the algorithm and human readers for measuring (i) lateral center edge angle of Wiberg (LCEA) and (ii) Acetabular index angle (AIA). The algorithm was based on deep-learning models developed using a modified U-net architecture and ResNet 34. The newly developed algorithm was found to be highly reliable when identifying the anatomical landmarks used for measuring LCEA and AIA in pelvic radiographs, thus offering highly consistent measurement outputs. The study showed that manual identification of the same landmarks made by five specialist readers were subject to variance and the level of agreement between the algorithm and human readers was consequently poor with mean measured differences from 0.37 to 9.56° for right LCEA measurements. The algorithm displayed the highest agreement with the senior orthopedic surgeon. With further development, the algorithm may be a good alternative to humans when screening for HD.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, 5000 Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
| | | | - Martin Haagen Haubro
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odense, Denmark
| | - Claus Varnum
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odense, Denmark
- Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of Southern Denmark, 7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Lene Bak
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | - Janne Rasmussen
- Department of Radiology, Odense University Hospital, 5700 Svendborg, Denmark
| | - Lone B. Olsen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | - Benjamin S. B. Rasmussen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
- Department of Radiology, Odense University Hospital, 5700 Svendborg, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence), Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark
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29
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O'Brien MJM, Jacobsen JS, Semciw AI, Mechlenburg I, Tønning LU, Stewart CJW, Heerey J, Kemp JL. Physical impairments in Adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis. Int J Sports Phys Ther 2022; 17:988-1001. [PMID: 36237653 PMCID: PMC9528691 DOI: 10.26603/001c.38166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is a condition associated with hip pain and impairments. Periacetabular osteotomy (PAO) is a common surgical treatment for DDH. Outcomes following PAO have historically been based on radiology or patient reported outcomes, and not physical impairments. Objective To investigate differences in physical impairments in adults with DDH undergoing PAO compared with asymptomatic participants, and to investigate pre- to post-PAO changes in physical impairments. Design Systematic review with meta-analysis. Methods A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO), using the PRISMA checklist. Studies were considered eligible if patients were aged 15 years and older, treated with PAO for DDH and if they included a physical impairment outcome measure. Two independent reviewers performed data extraction and assessed methodological quality, using a modified version of the Downs and Black checklist. Results Of 5,017 studies, 24 studies were included with 2190 patients. The methodological quality scores ranged from 39% to 88%. With low level of evidence, meta-analysis showed 58% of patients had a positive anterior impingement test (95%CI: 39-76%), prior to PAO and one to three years after PAO. Five years after PAO, the proportion fell to 17% (95%CI: 11-24%). Prior to PAO, patients with DDH walked with a lower peak hip extension angle, compared to asymptomatic participants (SMD 0.65 (95%CI 0.21-1.10). Best evidence synthesis of non-pooled data showed limited evidence of increased walking velocity, stride length and improved hip flexion and extension moment 18-months post-PAO compared to pre-op. Cadence, hip abduction and hip flexion strength did not change. Conclusion Most patients with DDH have a positive hip impingement test, pre-PAO. Compared to asymptomatic participants, patients with DDH demonstrate physical impairments during walking which appear to improve after surgery. Hip abduction and flexion strength did not change pre- to post-PAO. Level of Evidence 1b.
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Affiliation(s)
- Michael J M O'Brien
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Julie S Jacobsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark; Research Unit for General Practice, Aarhus, Denmark
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthortics, La Trobe University, Bundoora, Victoria, Australia
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa U Tønning
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Chris J W Stewart
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Thummala AR, Xi Y, Middleton E, Kohli A, Chhabra A, Wells J. Does surgery change pelvic tilt? : an investigation in patients with osteoarthritis of the hip, dysplasia, and femoroacetabular impingement. Bone Joint J 2022; 104-B:1025-1031. [PMID: 36047020 DOI: 10.1302/0301-620x.104b9.bjj-2022-0095.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. METHODS The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). RESULTS The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). CONCLUSION There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients.Cite this article: Bone Joint J 2022;104-B(9):1025-1031.
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Affiliation(s)
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Population Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emily Middleton
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ajay Kohli
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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31
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Beckmann NA, Bangert Y, Putz C, Götze M, Renkawitz T, Hagmann S. [Treatment of hip dysplasia in young adults]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:763-774. [PMID: 35867116 DOI: 10.1007/s00132-022-04281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Developmental dysplasia of the hip (DDH) is one of the most common disorders of hips in children. The deformity can remain asymptomatic into adolescence and adulthood; however, it is considered to be a form of prearthritis and is the main cause of premature osteoarthritis of the hip. The deformity affects the acetabulum but can also be accompanied by changes in the shape of the proximal femur. If conservative treatment for mild DDH is insufficient, or in cases of moderate to severe DDH, operative treatment should be carried out, for example by corrective osteotomy of the pelvis and/or the proximal femur and hip arthroscopy may be considered adjunctively in order to resolve the prearthritis and prevent premature osteoarthritis of the hip. This manuscript elucidates the deformity, the diagnostic measures required to make the diagnosis and the treatment options available for prevention of arthritis.
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Affiliation(s)
- N A Beckmann
- Orthopädische Universitätsklinik Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland.
| | - Y Bangert
- Orthopädische Universitätsklinik Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland
| | - C Putz
- Orthopädische Universitätsklinik Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland
| | - M Götze
- Orthopädische Universitätsklinik Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland
| | - T Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland
| | - S Hagmann
- Orthopädische Universitätsklinik Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200A, 69118, Heidelberg, Deutschland
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32
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Abstract
AIMS The aim of this study was to understand the experience of mature patients who undergo a periacetabular osteotomy (PAO), a major hip-preserving surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to improve our understanding of how the operation affected the lives of patients and their families, with a long-term goal of improving their experience. METHODS We used a phenomenological approach with in-depth, semi-structured interviews to investigate the experience of seven female patients, aged between 25 and 40 years, who underwent a PAO. A modified homogeneity sampling approach coupled with criterion sampling was used. Inclusion criteria involved having at least one child at home and being in a committed relationship with a spouse or partner. RESULTS Analysis of interview transcripts revealed five major themes: feelings of frustration before having a treatment plan; fear of the operation; the importance of understanding the procedure in order to feel in control of their care; feelings of helplessness, dependence, and depression during recovery; and the need for support during recovery. CONCLUSION Our findings suggest that both the physical and psychosocial burdens of undergoing a PAO are great, with a major impact on the patient and their family. Many important issues lie outside the scope of what healthcare teams currently address. Cite this article: Bone Joint J 2022;104-B(7):781-785.
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O’Brien MJM, Jones DM, Semciw AI, Balakumar J, Grabinski R, Roebert J, Coburn GM, Mechlenburg I, Kemp JL. Does the use of i-FACTOR bone graft affect bone healing in those undergoing periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH)? A retrospective study. J Hip Preserv Surg 2022; 9:165-171. [PMID: 37063347 PMCID: PMC10093896 DOI: 10.1093/jhps/hnac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/02/2022] [Accepted: 05/11/2022] [Indexed: 04/18/2023] Open
Abstract
ABSTRACT
The aims of this study were to compare, in patients with and without the use of i-FACTOR bone graft during periacetabular osteotomy (PAO) surgery for developmental dysplasia of the hip (DDH), (i) bone healing at six-weeks post-operatively (ii) rate of complications. This was a retrospective review of case records. Participants were people aged 15-50 years undergoing rectus-sparing minimally invasive PAO surgery for DDH. Group 1: patients with i-FACTOR, Group 2: No i-FACTOR. The primary outcome was the rate of bone healing on radiographs at 6 weeks. The likelihood of bone healing was compared using logistic regression with Generalised Estimating Equations (GEE) and expressed as odds ratios (95% confidence intervals (CIs; P < 0.05)). The occurrence of complications was extracted from surgical records. The i-FACTOR group had 3-times greater odds of partial/full union than those without [adjusted odds ratio (95% CIs, P-value)]: [3.265 (1.032 to 10.330, P = 0.044)]. The i-FACTOR group had 89% partial/full union at 6-weeks, compared to 69% of the non-i-FACTOR group. Half of the patients had leaking of bone graft in the i-FACTOR group versus 10% in the non-i-FACTOR group, 26% of the i-FACTOR group and 12% of the non-i-FACTOR group had neuropraxia of the lateral femoral cutaneous nerve (LFCN). Complication rates were low, and similar between groups. However, the rate of LFCN neuropraxia and bone graft leakage was higher in the i-FACTOR. These findings should be confirmed in a future prospective randomised clinical trial and include outcomes such as pain and quality of life.
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Affiliation(s)
| | | | - Adam Ivan Semciw
- Department of Physiotherapy, Podiatry, and
Prosthetics and Orthotics, La Trobe University, Melbourne, VIC 3086,
Australia
| | | | - Rafal Grabinski
- Victoria House Imaging, I-Med
Radiology, Melbourne, VIC 3141, Australia
| | - Justin Roebert
- Victoria House Imaging, I-Med
Radiology, Melbourne, VIC 3141, Australia
| | - Georgia M Coburn
- La Trobe Sport and Exercise Medicine Research
Centre, La Trobe University, Melbourne, VIC 3086, Australia
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University
Hospital, Aarhus 8200, Denmark
- Department of Clinical Medicine, Aarhus
University, Aarhus 8200, Denmark
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34
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Harris MD, Shepherd MC, Song K, Gaffney BM, Hillen TJ, Harris-Hayes M, Clohisy JC. The biomechanical disadvantage of dysplastic hips. J Orthop Res 2022; 40:1387-1396. [PMID: 34415648 PMCID: PMC8858333 DOI: 10.1002/jor.25165] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is strongly associated with an increased risk for hip osteoarthritis. Skeletal deformities undeniably contribute to detrimental biomechanical loading in dysplastic hips, but cannot explain all types of damage and symptoms that patients with DDH experience. Characterizing the geometry and function of the muscles spanning the hip is a logical next step in our progression of knowledge about DDH pathomechanics. In this study, we compared skeletal geometry, muscle volumes, intramuscular fatty infiltration, moment arms, and isometric strength in patients with DDH (N = 20) to healthy controls (N = 15). Femoral coverage was significantly less in patients (p < 0.001, Cohen's d effect size = 2.2), femoral neck-shaft angles were larger (p = 0.001, d = 1.3), and hip joint centers (HJCs) were more lateral (p = 0.001, d = 1.3). These skeletal abnormalities were associated with smaller abductor muscle moment arms in patients with DDH (e.g., gluteus medius [GMED]: p = 0.001, d = 1.2). Patients with DDH also had larger GMED volumes (p = 0.02, d = 0.83), but no differences in fatty infiltration, compared to controls. Isometric strength of the hip abductors, extensors, and flexors was lower in patients, but not significantly different from controls. The abnormal skeletal geometry, lateralized HJC, and reduced muscle moment arms represent a chronic biomechanical disadvantage under which patients with DDH operate. This phenomenon causes increased demand on the abductor muscles and results in high medially and superiorly directed joint reaction forces, which can explain reports of superomedial femoral cartilage damage in patients. The abnormal muscle geometry and function, in context with abnormal skeletal structure, are likely strong, but underappreciated, contributors to damaging loads in DDH.
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Affiliation(s)
- Michael D. Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Molly C. Shepherd
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Ke Song
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Brecca M.M. Gaffney
- Department of Mechanical Engineering, University of Colorado-Denver, Denver, CO
| | - Travis J. Hillen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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35
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Asymmetry in Muscle Strength, Dynamic Balance, and Range of Motion in Adult Symptomatic Hip Dysplasia. Symmetry (Basel) 2022. [DOI: 10.3390/sym14040748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Hip dysplasia (HD) is a typical developmental abnormality of the hip joint, and discomfort is often found in adulthood. This study compared patients with symptomatic HD in muscle strength, dynamic balance, and range of motion (ROM) with healthy individuals. Patients included those who complained of unilateral pain although the lateral center edge angle (LCEA) exhibited bilateral abnormality. Participants (n = 95; men: 46, women: 49) were divided into symptomatic and asymptomatic sides, and a healthy group without a history of hip joint disease (n = 70; men: 30, women: 40) was compared. Hip flexion, extension, abduction, and adduction were performed at an angular velocity of 30°/s using an isokinetic strength test device. The Y-balance test was conducted to measure dynamic balance, and ROM was measured using an electronic goniometer to evaluate flexion, extension, adduction, abduction, and internal and external rotations. In addition, the pain visual analog scale (VAS) and hip and groin outcome scale (HAGOS), a subjective evaluation of the hip joint, were evaluated. ROM (flexion, abduction, internal rotation, and external rotation) was significantly decreased in the HD symptomatic sides of men and women compared to those of the healthy group and the asymptomatic side, and the dynamic balance, flexion, and abduction muscle strength were also lower on the symptomatic sides. Although the LCEA of the HD asymptomatic side was lower than that of the healthy group, there were no significant differences in VAS, flexion, extension, abduction ROM, and extension strength compared to those of healthy individuals. In conclusion, patients with HD were mostly bilateral, and on the symptomatic side, there was a decrease in ROM, dynamic balance, and muscle strength; however, on the asymptomatic side, the function was relatively close to normal.
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36
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Everett BP, Sherrill G, Nakonezny PA, Wells JE. The relationship between patient-reported outcomes and preoperative pain characteristics in patients who underwent total hip arthroplasty. Bone Jt Open 2022; 3:332-339. [PMID: 35440177 PMCID: PMC9044086 DOI: 10.1302/2633-1462.34.bjo-2021-0206.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations? Methods We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used. Results There was a significant difference in iHOT-12 scores between groups experiencing the most severe pain in the groin and the trochanter (p = 0.039). Additionally, more favourable mHHS scores were related to the presence of preoperative pain in trochanter (p = 0.049), lower back (p = 0.056), lateral thigh (p = 0.034), and posterior thigh (p = 0.005). Finally, the maximum severity of preoperative pain and number of pain locations had no significant relationship with PROMs (maximum severity: HHS: p = 0.928, HOS: p = 0.163, iHOT-12 p = 0.233; number of pain locations: HHS: p = 0.211; HOS: p = 0.801; iHOT-12: p = 0.112). Conclusion Although there was a significant difference in iHOT-12 scores between patients with the most severe pain in the groin or trochanter, and the presence of pain in the trochanter, lower back, lateral thigh, or posterior thigh was related to higher mHHS scores, the majority of preoperative pain characteristics did not have a significant impact on outcomes. Therefore, a broad array of patients with hip OA might expect similar, favourable outcomes from THA notwithstanding preoperative pain characteristics. Cite this article: Bone Jt Open 2022;3(4):332–339.
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Affiliation(s)
- Brandon Paul Everett
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Garrett Sherrill
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul A. Nakonezny
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joel E. Wells
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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37
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Herfkens J, van Buuren MMA, Riedstra NS, Verhaar JAN, Mascarenhas VV, Agricola R. Adding false-profile radiographs improves detection of developmental dysplasia of the hip, data from the CHECK cohort. J Hip Preserv Surg 2022; 9:3-9. [PMID: 35651710 PMCID: PMC9142192 DOI: 10.1093/jhps/hnac008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/09/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to determine the additional value of the false-profile (FP) view radiograph in the diagnosis of developmental dysplasia of the hip (DDH), as compared with an anteroposterior (AP) pelvic radiograph only, and evaluate the correlation between the Wiberg-lateral center edge angle (W-LCEA) and Wiberg-anterior center edge angle (W-ACEA). We used baseline data from a nationwide prospective cohort study (Cohort Hip and Cohort Knee). DDH was quantified on AP pelvic and FP hip radiographs using semi-automatic measurements of the W-LCEA and W-ACEA. A threshold of <20° was used to determine DDH for both the W-LCEA and the W-ACEA. The proportion of DDH only present on the FP view determined the FP view additional value. The correlation between the W-LCEA and W-ACEA was determined. In total 720 participants (1391 hips) were included. DDH was present in 74 hips (5.3%), of which 32 were only present on the FP view radiograph (43.2%). The Pearson correlation coefficient between W-LCEA and W-ACEA of all included hips was 0.547 (95% confidence interval: 0.503–0.591) and 0.441 (95% confidence interval: 0.231–0.652) in hips with DDH. A mean difference of 9.4° (SD 8.09) was present between the W-LCEA and the W-ACEA in the hips with DDH. There is a strong additional value of the FP radiograph in the diagnosis of DDH. Over 4 out of 10 (43.2%) individuals’ DDH will be missed when only using the AP radiograph. In hips with DDH a moderate correlation between W-LCEA and W-ACEA was calculated indicating that joints with normal acetabular coverage on the AP view can still be undercovered on the FP view.
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Affiliation(s)
- Julie Herfkens
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Michiel M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Noortje S Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Vasco V Mascarenhas
- MSK Imaging Unit (UIME), Imaging Center, Hospital da Luz, Lisbon, Indiana, Portugal
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38
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[Epidemiology, prevention and early detection of femoroacetabular impingement syndrome (FAIS)]. DER ORTHOPADE 2022; 51:167-175. [PMID: 35113212 DOI: 10.1007/s00132-022-04215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
During the last two decades femoroacetabular impingement syndrome (FAIS) has gained importance and is one of the main causes of hip pain in young adults. FAIS is a motion-related clinical pathology of the hip that represents symptomatic contact between the proximal femur and the acetabulum. Symptoms, clinical signs, and imaging findings must be present to diagnose FAIS. Especially the development of the cam-FAIS seems to be associated with an overuse of the growth plate during adolescence. Here an approach may be found for the prevention of the development of FAIS. Sufficient evidence through high-quality long-term results is yet lacking.
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39
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Everett BP, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia. J Hip Preserv Surg 2022; 9:44-50. [PMID: 35651711 PMCID: PMC9142189 DOI: 10.1093/jhps/hnac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/29/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.
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Affiliation(s)
- Brandon P Everett
- Medical School, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Paul A Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Edward P Mulligan
- School of Health Professions, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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40
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Alrashdi NZ, Motl RW, Aguiar EJ, Ryan MK, Perumean-Chaney SE, Ithurburn MP. Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes. J Hip Preserv Surg 2021; 8:367-381. [PMID: 35505808 PMCID: PMC9052429 DOI: 10.1093/jhps/hnab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022] Open
Abstract
Periacetabular osteotomy (PAO) is a surgery for persons with symptomatic acetabular dysplasia (AD) that increases acetabular coverage of the femoral head for reducing hip pain and improving function. Patient-reported outcomes (PROs) are significantly improved following PAO, yet little is known regarding mobility-related outcomes. This narrative review provides a synthesis of evidence regarding PROs and mobility-related outcomes in persons with AD following PAO. We further identified important future research directions, chiefly the need for measurement of real-world outcomes. We searched PubMed using comprehensive predefined search terms. We included studies that (i) enrolled persons with AD undergoing PAO, (ii) included PROs and/or mobility-related outcomes and (iii) were written in English. We synthesized and summarized study characteristics and findings. Twenty-three studies were included in this review. Commonly evaluated PROs included pain (n = 14), hip function (n = 19) and quality of life (n = 9). Mobility-related outcomes included self-reported physical activity (PA; n = 11), walking speed and cadence (n = 4), device-measured PA (n = 2), and sit-to-stand, four-square-step and timed stair ascent tests (n = 1). Persons with AD had significant improvements in PROs following PAO, yet mobility-related outcomes (e.g. walking speed and device-measured PA levels) did not change over 1 year following PAO. Few studies have evaluated mobility-related outcomes following PAO, and these studies were of a low methodological quality. Future research might include experience sampling data collection approaches and body-worn devices as free-living, technology-driven methodologies to evaluate mobility and other outcomes in persons with AD undergoing PAO.
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Affiliation(s)
- Naif Z Alrashdi
- Department of Physical Therapy, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL 35233, USA
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Kingdom of Saudi Arabia
| | - Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL 35233, USA
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, 1919 W. Taylor St. 650 AHSB (MC 517), Chicago, IL 60612, USA
| | - Elroy J Aguiar
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Michael K Ryan
- The Hip Center, Andrews Sports Medicine and Orthopaedic Center, OrthoSports Center at St. Vincent's Birmingham 805 St. Vincent's Drive, Ste. 100, Birmingham, AL 35205, USA
| | - Suzanne E Perumean-Chaney
- Department of Biostatistics, The University of Alabama at Birmingham, 1665 University Blvd #327, Birmingham, AL 35294, USA
| | - Matthew P Ithurburn
- Department of Physical Therapy, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL 35233, USA
- American Sports Medicine Institute, 833 St Vincents Dr #205, Birmingham, AL 35205, USA
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Harris-Hayes M, Steger-May K, Bove AM, Mueller MJ, Clohisy JC, Fitzgerald GK. One-year outcomes following physical therapist-led intervention for chronic hip-related groin pain: Ancillary analysis of a pilot multicenter randomized clinical trial. J Orthop Res 2021; 39:2409-2418. [PMID: 33458839 PMCID: PMC8285461 DOI: 10.1002/jor.24985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Evidence related to physical therapist-led intervention for patients with chronic hip-related groin pain (HRGP) is limited. The purpose was to assess sustainability of treatment effects for people with HRGP undergoing two physical therapist-led interventions. We completed an ancillary analysis of a pilot multicenter, randomized clinical trial. Forty-six patients with chronic HRGP, 15-40 years, were enrolled. Patients were randomized to participate in 10 sessions over 12 weeks of either movement pattern training (MoveTrain) or traditional strength/flexibility (Standard). Participants completed self-report questionnaires before treatment and 6 and 12 months after treatment completion. Outcome measures included Hip disability and Osteoarthritis and Outcome Score (HOOS), Patient Specific Functional Scale and Numeric Pain Rating Scale for average and worst pain. Continuous data were analyzed with mixed model repeated measures analysis of variance (RM-ANOVA) within each group. Numeric pain rating scale (NPRS) was analyzed using multinomial generalized estimating equations (GEE) with a cumulative logit. Reported p values are from statistical contrasts within the RM-ANOVAs and GEEs testing a priori hypotheses regarding change from pretest to month 6, and pretest to month 12. A total of 43/46 (93.5%) participants completed treatment, 40 (87.0%) completed 6 and 38 (82.6%) completed 12 month questionnaires. At 6 and 12 months, both groups demonstrated clinically significant improvements, compared to pretest, in all subscales of HOOS (p < 0.01), Patient Specific Functional Scale (p < 0.001), and NPRS (p < 0.0001). Among patients with chronic HRGP, both MoveTrain and Standard resulted in improved outcomes that were sustained 12 months after treatment. Further investigation in a larger sample is needed to confirm our findings.
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Affiliation(s)
- Marcie Harris-Hayes
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Allyn M. Bove
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J. Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - G. Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Gu Y, Jin W, Zhang H, Shi Z, Yue Y, Yan Z, Zhao Z, Li S, Yan X. What are the significant factors affecting pain in patients with Hartofilakidis type Ι developmental dysplasia of the hip? J Orthop Surg Res 2021; 16:611. [PMID: 34663364 PMCID: PMC8522044 DOI: 10.1186/s13018-021-02761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To explore the influencing factors of age at onset of pain and severe pain in patients with Hartofilakidis type I developmental dysplasia of the hip (DDH). Methods A retrospective study of 83 patients with DDH treated at our hospital from January 2017 to June 2021 was conducted. The age at onset of pain, patients’ demographic data, and radiographic parameters were collected. Multiple linear regression was used to determine the influencing factors of age at onset of pain. Cox regression analysis was used to determine the influencing factors of severe pain attacks. Results According to the results of multiple linear regression analysis, when the distance between the medial femoral head and the ilioischial line increased by one millimetre, the age at onset of pain decreased by 1.7 years (β = − 1.738, 95% CI − 1.914–[− 1.561], p < 0.001). When the sharp angle increases by one degree, the age at onset of pain decreases by 0.3 years (β = − 0.334, 95% CI − 0.496–[− 0.171], p < 0.001). According to the results of the Cox regression analysis, for each additional degree of the lateral centre-edge angle (LCEA), the probability of severe pain was reduced by 5% (Exp [β]: = 0.947, 95% CI 0.898–0.999, p = 0.044). For each additional millimetre in the distance between the medial femoral head and the ilioischial line, the likelihood of severe pain increased by 2.4 times (Exp [β]: 2.417, 95% CI 1.653–3.533, p < 0.001). Conclusion Larger distances between the medial femoral head and the ilioischial line and sharp angle can lead to an earlier age at onset of pain in patients with DDH. Small LCEA and excessive distance between the medial femoral head and the ilioischial line are risk factors for severe pain.
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Affiliation(s)
- Yange Gu
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China
| | - Wenshu Jin
- School of Sports Medicine and Rehabilitation, Shandong First Medical University & Shandong Academy of Medical Sciences, 619 Great Wall Road, Tai'an, 271000, Shandong, China.,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Han Zhang
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China
| | - Zhiwei Shi
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China.,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Yaohui Yue
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China.,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Zhaolong Yan
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Zhang Zhao
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Shufeng Li
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Xinfeng Yan
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China. .,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China.
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Leide R, Bohman A, Wenger D, Overgaard S, Tiderius CJ, Rogmark C. Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults. Acta Orthop 2021; 92:575-580. [PMID: 34238106 PMCID: PMC8519544 DOI: 10.1080/17453674.2021.1936918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hip dysplasia in adults is a deformity in which the acetabulum inadequately covers the femoral head. The prevalence is sparingly described in the literature. We investigated the prevalence in Malmö (Sweden) and assessed whether the condition was recognized in the radiology reports.Subjects and methods - All pelvic radiographs performed in Malmö during 2007-2008 on subjects aged 20-70 years with a Swedish personal identity number were assessed. 1,870 digital radiographs were eligible for analysis. The lateral center-edge angle (LCEA) and acetabular index angle (AIA) were measured. Hip dysplasia was defined as an LCEA ≤ 20°. Intraclass correlation coefficients (ICC) for intra-observer measurements ranged from 0.87 (AIA, 95% CI 0.78-0.93) to 0.98 (LCEA, CI 0.97-0.99).Results - The prevalence of hip dysplasia (LCEA ≤ 20°) was 5.2% (CI 4.3-6.3), (98/1,870). There was no statistically significant difference between the sexes for either prevalence of hip dysplasia or mean LCEA. The mean AIA was 0.9° (CI 0.3-1.3) higher in men (4.1 SD 5.5) compared with women (3.2 SD 5.4). The radiologists had reported hip dysplasia in 7 of the 98 cases.Interpretation - The prevalence of hip dysplasia in Malmö (Sweden) is similar to previously reported data from Copenhagen (Denmark) and Bergen (Norway). Our results indicate that hip dysplasia is often overlooked by radiologists, which may influence patient treatment.
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Affiliation(s)
- Rebecka Leide
- Department of Clinical Sciences, Lund University, Lund, Sweden,Department of Orthopedics, Halland Hospital, Halmstad, Sweden,Correspondence: Rebecka LEIDE Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Bohman
- Department of Emergency Medicine, Central Hospital, Kristianstad, Sweden
| | - Daniel Wenger
- Department of Clinical Sciences, Lund University, Lund, Sweden,Department of Orthopedics, Skåne University Hospital, Lund and Malmö, Sweden
| | - Søren Overgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Carl Johan Tiderius
- Department of Clinical Sciences, Lund University, Lund, Sweden,Department of Orthopedics, Skåne University Hospital, Lund and Malmö, Sweden
| | - Cecilia Rogmark
- Department of Clinical Sciences, Lund University, Lund, Sweden,Department of Orthopedics, Skåne University Hospital, Lund and Malmö, Sweden
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Gao R, Zhu Z, Xie Z. [Mid-term effectiveness of periacetabular osteotomy through modified ilioinguinal approach for acetabular dysplasia in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1100-1104. [PMID: 34523273 DOI: 10.7507/1002-1892.202104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the mid-term effectiveness of periacetabular osteotomy (PAO) through modified ilioinguinal approach for acetabular dysplasia in adults. Methods Between January 2016 and December 2018, 39 patients (43 hips) with acetabular dysplasia who met the selection criteria were enrolled in the study and their clinical data were retrospectively analyzed. All patients were treated with PAO via modified ilioinguinal approach (firstly, the skin and superficial facia were cut via the traditional ilioinguinal approach, and the deep tissues were cut via the modified iliac-femoral approach). There were 3 males (3 hips) and 36 females (40 hips) with an average age of 36 years (range, 18-51 years). Among them, 35 cases of lesions involved single hip and 4 cases of lesions involved bilateral hips. The disease duration ranged from 4 to 96 months, with a median of 18 months. According to the modified Tönnis grading for osteoarthritis, 35 hips were classified as grade 0, 6 hips as grade Ⅰ, and 2 hips as grade Ⅱ. All patients had different degrees of hip pain. The preoperative visual analogue scale (VAS) score of pain was 4.7±0.8, and the modified Harris hip score was 78.5±8.6. The lateral centre-edge angle (LCEA) was (10.52±10.83)°, and the acetabular index (AI) was (26.89±9.07) °. The operation time, intraoperative blood loss, and the incidence of complications were recorded. LCEA, AI, and the progression of osteoarthritis were reviewed by X-ray films. The function and pain of hip joint were evaluated by modified Harris hip score and VAS score. Results All operations were successfully completed. The operation time was 90-150 minutes, with an average of 130 minutes. The volume of intraoperative blood loss was 350-600 mL, with an average of 500.6 mL. All patients were followed up 17-52 months, with an average of 32.7 months. Postoperative numbness of the lateral femoral cutaneous nerve occurred in 3 cases, and no other complications occurred. At last follow-up, the modified Harris hip score was 97.7±3.7 and VAS score was 0.9±1.1, both of which were better than those before operation ( P<0.05). At 1 year after operation, X-ray films showed that the all osteotomies healed. In term of the modified Tönnis grading for osteoarthritis, 1 hip downgraded from grade 1 to grade 0, while the remaining hips stayed unchanged. At last follow-up, LCEA and AI were (27.54±8.49) ° and (11.30±5.53) °, respectively, which were significantly different from those before operation ( P<0.05). Conclusion PAO through modified ilioinguinal approach is effective in relieving pain and restoring hip function in adults with acetabular dysplasia, which can overcome the disadvantages of the traditional ilioinguinal approach, and may delay the development of osteoarthritis.
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Affiliation(s)
- Renzhi Gao
- Department of Orthopedics, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Zhaochen Zhu
- Department of Orthopedics, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Zongping Xie
- Department of Orthopedics, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
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Chinzei N, Hashimoto S, Hayashi S, Nakano N, Haneda M, Kuroda Y, Matsumoto T, Kuroda R. Patients' Characteristics Can Predict Clinical Outcomes Following Hip Arthroscopy by Reflecting the Patterns of Labral Tears: A Retrospective Observational Study. Indian J Orthop 2021; 56:295-302. [PMID: 35140861 PMCID: PMC8789971 DOI: 10.1007/s43465-021-00481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/06/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the relationship between morphological differences in labral tears and clinical features of the hip joint in patients who underwent hip arthroscopy. MATERIALS AND METHODS We retrospectively analyzed data from patients who underwent arthroscopic surgery for the treatment of labral tears. Hip labral tears were morphologically classified as longitudinal peripheral tears (group L), radial fibrillated tears (group FI), radial flaps (group FL), and an unstable labrum (group U). Radiographically, the center-edge angle, acetabular roof obliquity, vertical-center-anterior angle, alpha angle, femoral head-neck offset ratio, and crossover sign were evaluated and compared among the groups. The relationship between labral morphology and these radiographic findings, as well as clinical findings, such as age, gender, preoperative range of hip motion, and the clinical outcomes using modified Harris Hip Score (mHHS) were also examined. RESULTS This study included fifty patients. Groups L and FI were often observed in late middle-aged patients with relatively shallow acetabular coverage. Group FL tears were frequently observed in young males with radiographic features, such as femoroacetabular impingement (FAI), compared to the other groups. Group U comprised mostly young females with relatively shallow acetabular coverage compared to the other groups. For the postoperative mHHS, group FL showed the best score among all groups, with a significant difference between groups FL and FI (p = 0.034). CONCLUSIONS Our study revealed that morphologically, different labral tears were associated with different clinical features and radiological findings. Especially, our study can provide predictive findings for hip arthroscopists that younger males with FAI show better clinical outcomes when compared to middle-aged females with shallow acetabulum, which is indicative of degenerative hip labral tears. LEVEL OF EVIDENCE IV case series.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan ,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Masahiko Haneda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan ,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Sun J, Chhabra A, Thakur U, Vazquez L, Xi Y, Wells J. The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome : a cross-sectional evaluation of a prospective hip registry cohort. Bone Joint J 2021; 103-B:1351-1357. [PMID: 34334048 DOI: 10.1302/0301-620x.103b8.bjj-2020-2481.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies. METHODS In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD. RESULTS Out of 122 patients, 110 (90.2%) were female and 12 (9.8%) were male. We analyzed the radiographs of 122 hips (59 (48.4%) symptomatic left hips, and 63 (51.6%) symptomatic right hips). Average age at time of presentation was 34.2 years (SD 11.2). Frequency of LSTV was high (39% to 43%), compared to historic records from the general population, with Castellvi type 3b being the most common (60% to 63%). Patients with AD have increased L4 and L5 interpedicular distance compared to published values. Frequency of pars interarticularis defect was 4%. Intraclass correlation coefficient for hip and spine variables assessed ranged from good (0.60 to 0.75) to excellent (0.75 to 1.00). Severity of AD did not demonstrate significant correlation with frequency of radiological spine anomalies. CONCLUSION Patients with AD have increased frequency of spinal anomalies seen on standard hip radiographs. However, there exists no correlation between radiological severity of AD and frequency of spine anomalies. In managing AD patients, clinicians should also assess spinal anomalies that are easily found on standard hip radiographs. Cite this article: Bone Joint J 2021;103-B(8):1351-1357.
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Affiliation(s)
- Joshua Sun
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern, Dallas, Texas, USA
| | - Uma Thakur
- Department of Radiology, University of Texas Southwestern, Dallas, Texas, USA
| | - Louis Vazquez
- Department of Radiology, University of Texas Southwestern, Dallas, Texas, USA
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern, Dallas, Texas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
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Editorial Commentary: An Optimal Classification System to Guide Prognosis and Treatment in Greater Trochanteric Pain Syndrome: Now We're Speaking the Same Language. Arthroscopy 2021; 37:2137-2139. [PMID: 34226004 DOI: 10.1016/j.arthro.2021.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
The optimal classification system in arthroscopic and related surgery research and clinical practice should be clinically relevant, descriptive, reproducible, simple, inexpensive, safe, and widely applicable. For the hip, classification systems that characterize intra-articular disorders like femoroacetabular impingement (FAI) syndrome, dysplasia, labral tears, and articular cartilage disease predominate the literature. Recently, awareness of peritrochanteric and other extra-articular disorders has increasingly led to greater recognition, diagnosis, and treatment of what has been historically known as "just bursitis". These disorders are far more complex and include greater trochanteric pain syndrome, the spectrum of gluteal tendon pathology, greater trochanteric bursitis, snapping iliotibial band (external coxa saltans), and greater trochanteric-ischial impingement. The utility of an intraoperative greater trochanteric pain syndrome classification system has now been proven using prospectively collected data, assimilating a decade-long eligibility period following open or endoscopic treatment of peritrochanteric disorders with a minimum two-year follow-up using validated patient-reported outcome scores. This classification guides prognosis and treatment, exactly as an optimal orthopedic classification system should do.
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Jacobsen JS, Jakobsen SS, Søballe K, Hölmich P, Thorborg K. Isometric hip strength impairments in patients with hip dysplasia are improved but not normalized 1 year after periacetabular osteotomy: a cohort study of 82 patients. Acta Orthop 2021; 92:285-291. [PMID: 33538223 PMCID: PMC8231359 DOI: 10.1080/17453674.2020.1864911] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In patients with hip dysplasia, knowledge of hip muscle strength after periacetabular osteotomy is lacking. We investigated isometric hip muscle strength in patients with hip dysplasia, before and 1 year after periacetabular osteotomy, and compared this with healthy volunteers. Furthermore, we investigated whether pre- to post-surgical changes in self-reported pain and sporting function were associated with changes in isometric hip muscle strength.Patients and methods - Isometric hip muscle strength was assessed twice in 82 patients (11 men) with a mean age of 30 (SD 9) years, before and 1 year after surgery, and once in 50 healthy volunteers. Isometric hip muscle strength was assessed with a hand-held dynamometer. Copenhagen Hip and Groin Outcome Score was used to measure self-reported outcome.Results - Despite 1-year improvements in isometric hip flexion (0.1 Nm/kg; 95% CI 0.06-0.2) and abduction (0.1 Nm/kg; CI 0.02-0.2), the patients' muscle strength was 13-34% lower than the strength of the healthy volunteers both pre- and post-surgery (p < 0.01). Moreover, changes in self-reported pain were associated with changes in hip flexion (13 points per Nm/kg; CI 1-26) and abduction (14 points per Nm/kg; CI 3-25), while changes in self-reported sporting function were associated with changes in hip extension (9 points per Nm/kg; CI 1-18).Interpretation - Isometric hip muscle strength is impaired in symptomatic dysplastic hips measured before periacetabular osteotomy. 1 year after surgery, isometric hip flexion and abduction strength had improved but muscle strength did not reach that of healthy volunteers.
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Affiliation(s)
- Julie Sandell Jacobsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus; ,Research Unit for General Practice in Aarhus, Aarhus; ,Correspondence:
| | | | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus; ,Department of Clinical Medicine, Aarhus University, Aarhus;
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre;
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre; ,Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
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Gaffney BM, Van Dillen LR, Foody JN, Burnet PE, Clohisy JC, Chen L, Harris MD. Multi-joint biomechanics during sloped walking in patients with developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2021; 84:105335. [PMID: 33812201 PMCID: PMC8845490 DOI: 10.1016/j.clinbiomech.2021.105335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/22/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip is characterized by abnormal acetabular and femoral geometries that alter joint loading and increase the risk of hip osteoarthritis. Current understanding of biomechanics in this population remains isolated to the hip and largely focused on level-ground walking, which may not capture the variable loading conditions that contribute to symptoms and intra-articular damage. METHODS Thirty young adult females (15 with dysplasia) underwent gait analysis during level, 10° incline, and 10° decline walking while whole-body kinematics, ground reaction forces, and electromyography (EMG) were recorded. Low back, hip, and knee joint kinematics and internal joint moments were calculated using a 15-segment model and integrated EMG was calculated within the functional phases of gait. Dependent variables (peak joint kinematics, moments, and integrated EMG) were compared across groups with a one-way ANOVA with multiple comparisons controlled for using the Benjamini-Hochberg method (α = 0.05). FINDINGS During level and incline walking, patients with developmental dysplasia of the hip had significantly lower trunk flexion angles, lumbar and knee extensor moments, and erector spinae activity than controls. Patients with developmental dysplasia of the hip also demonstrated reduced rectus femoris activity during loading of level walking and increased gluteus maximus activity during mid-stance of decline walking. INTERPRETATION Patients with developmental dysplasia of the hip adopt compensations both proximal and distal to the hip, which vary depending on the slope of walking. Furthering the understanding of multi-joint biomechanical compensations is important for understanding the mechanism of osteoarthritis development as well as secondary conditions.
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Affiliation(s)
- Brecca M.M. Gaffney
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Linda R. Van Dillen
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Paige E. Burnet
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael D. Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA,Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA,Corresponding author at: Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO 63108, United States. (M.D. Harris)
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