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Lerch S, Zimmerer A, Puljic P, Rühmann O. Amorphous calcium deposits of the hip joint: current observations and state of the scientific discussion. Arch Orthop Trauma Surg 2022; 143:2647-2652. [PMID: 36074172 DOI: 10.1007/s00402-022-04561-8] [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: 01/12/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION As a result of increasing hip arthroscopies, rare pathologies as intra-articular amorphous calcium deposits in the capsule-labral (perilabral) recess can be recognized. There is a lack of publications on this pathology. The largest case series included 18 patients. An association between femoroacetabular impingement syndrome (FAIS) and female sex was observed. Furthermore, a correlation between the size of the calcific deposit and the preoperative hip function score was reported. Our hypothesis was that the data of our patient collective with intraoperative amorphous calcium deposits of the hip joint are comparable to the existing data to confirm previous observations. MATERIALS AND METHODS From 01/2018 to 08/2020, a total of 714 hip arthroscopies were performed. 12 (1.7%) patients who presented intra-articular amorphous calcium deposits during arthroscopy were included. On radiographs, signs of impingement and osteoarthritis were determined. Characteristics and size of the calcific deposits were examined. Preoperative and at the time of follow-up (23 months), patient-reported outcome scores (PROS) were evaluated. Duration of symptoms, pain medication, comorbidities, and return-to-work were evaluated too. RESULTS The PROS of the four female and eight male patients improved significantly. The average size of the calcific deposit was 6.9 mm in the anteroposterior radiographs. Separation of the calcific deposit from the acetabular rim was seen in nine cases. No correlation between deposit sizes and PROS was found. Cam morphology was treated in ten cases. All patients returned to work after a median of 7 weeks (2.5-13 weeks). CONCLUSION Amorphous calcium deposits were found in approximately 1% of all hip joints with indication for hip arthroscopy. They are not consistently associated with gender, intra-articular hip pathologies or comorbidities. The clustered occurrence in cam FAI can be justified solely by the fact that impingement is by far the most common indication for hip arthroscopy.
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Affiliation(s)
- Solveig Lerch
- Clinic for Orthopaedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen/Klinikum Region Hannover, Hildesheimer Str. 158, 30880, Laatzen, Germany.
- MVZ Jever, Orthopaedics and Trauma Surgery, Bahnhofstraße 1, Jever, Germany.
| | | | - Patrik Puljic
- Clinic for Orthopaedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen/Klinikum Region Hannover, Hildesheimer Str. 158, 30880, Laatzen, Germany
| | - Oliver Rühmann
- Clinic for Orthopaedics, Traumatology and Sports Medicine, Klinikum Agnes Karll Laatzen/Klinikum Region Hannover, Hildesheimer Str. 158, 30880, Laatzen, Germany
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Ju X, Xu Y, Zhang X, Huang H, Dai L, Wang J. Clinical outcomes after arthroscopic treatment of calcification with surrounding inflammation in the hip labrum. Knee Surg Sports Traumatol Arthrosc 2021; 29:2819-2824. [PMID: 34213587 DOI: 10.1007/s00167-021-06638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to investigate the surgical methods and clinical outcomes of arthroscopic treatment of a special type of calcification with surrounding inflammation in the acetabular labrum of the hip, which was temporarily named "calcifying labrumitis". METHODS From April 2015 to November 2019, a total of seven patients with calcifying labrumitis of the hip who underwent arthroscopic excision of calcified lesions and suture or partial resection of the labrum were included in this study. Radiographs were retrospectively evaluated for morphologic characteristics of calcifying labrumitis. Each patient was assessed by the visual analogue scale (VAS), modified Harris hip score (mHHS), nonarthritic hip score (NAHS) and satisfaction rate before surgery and at the final follow-up evaluation. RESULTS Seven patients, one male and six females aged 29-48 years, were included in the study; of these patients, three had calcifying labrumitis on the left side and four had calcifying labrumitis on the right side. All patients had hip pain and limited range of motion for a mean of 7.5 ± 3.1 months (range, 3-12 months). The mean follow-up period was 34.9 ± 19.5 months (range, 12-66 months). The lateral central-edge angle (LCEA) was 31.7 ± 3.9° (range, 28.8-36.4°), and the α angle was 41.4 ± 5.3° (range, 33.6-48.2°). None of the patients had cam or pincer lesions. After complete removal of calcified lesions, five patients underwent repair of the labrum with a suture anchor, and two patients underwent partial resection of the labrum. The symptoms of all patients improved significantly at the last follow-up. Mean scores improved from 5.8 ± 1.5 to 1.1 ± 0.3 (p < 0.01) for the VAS, from 57.3 ± 10.6 to 90.8 ± 13.4 for the mHHS and from 62.5 ± 10.7 to 84.3 ± 9.6 for the NAHS. The satisfaction rate was 100%. CONCLUSION Calcifying labrumitis of the hip is a special kind of rare disease that is different from calcifications accompanying FAI and os acetabuli. Arthroscopic treatment of calcification with suture or partial resection of the labrum is an effective, safe and minimally invasive method, significantly relieving pain and improving hip joint function. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Xiaodong Ju
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Yan Xu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Xin Zhang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Hongjie Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Linghui Dai
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Jianquan Wang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China.
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Zhang BQ, An MY, Gao F, Li CB, Wei Q, Hu B, Yuan W, Lu M, Liu YF, Liu YJ. Clinical Outcomes of Hip Arthroscopy for Hip Labrum Calcification in Young and Middle-Aged Patients. Orthop Surg 2021; 13:1244-1253. [PMID: 33943016 PMCID: PMC8274186 DOI: 10.1111/os.12998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the methods and outcomes of hip arthroscopy for hip labrum calcification, and to discuss the clinical, imaging, and intraoperative findings of hip labrum calcification. METHODS This is a therapeutic case series study. From January 2015 to June 2018, 15 patients who met the inclusion and exclusion criteria were followed up for at least 2 years for an analysis on the outcomes of arthroscopy in the treatment of hip labrum calcification and the clinical, imaging, and intraoperative findings of the patients. There were eight males and seven females, with an average age of 38.9 ± 8.8 years (range, 23-50 years). The visual analog scale (VAS), the modified Harris hip score (mHSS), and the international hip outcome tool (iHOT-12) were used to evaluate the outcomes of surgery. RESULTS A total of 15 patients were followed up for at least 2 years (28.1 ± 2.9 months). The average calcified volume was 118.0 mm3 (range, 19.4-609.2 mm3 ) and calcified volume was related to the preoperative hip function score. Thirteen patients had pain in the groin area (86.7%). Labrum calcifications were located (according to the clock distribution) as follows: 14 patients were anterior and superior (11:00-3:00); 12 cases of femoroacetabular impingement (FAI) were observed during operation, including five cases of pincer type, two cases of cam type, and five cases of mixed type. VAS pain score means were 7.73 ± 1.28 before surgery, decreasing to 2.0 ± 0.89 and 1.73 ± 0.79 at 1 and 2 years post-surgery, respectively. mHSS scores were 57.40 ± 6.23 before surgery and 82.10 ± 4.76 and 83.18 ± 4.07, 1 and 2 years post-surgery, respectively; iHOT-12 mean score pre-surgery was 37.67 ± 4.85, increasing to 67.64 ± 5.30 and 72.18 ± 4.49, 1 and 2 years post-surgery, respectively. Compared with preoperative values, postoperative VAS, mHSS, and iHOT-12 scores were significantly improved (P < 0.01); iHOT-12 scores also significantly decreased from 1 to 2 years postoperatively (P = 0.034). No patient had complications. CONCLUSION Hip arthroscopy is an effective method for the treatment of hip labrum calcification. The size of calcification influenced preoperative symptoms and function. Long-term irritation from FAI may be one important cause of labrum calcification.
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Affiliation(s)
- Bai-Qing Zhang
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Ming-Yang An
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Feng Gao
- Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Chun-Bao Li
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Qi Wei
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Bo Hu
- Department of Orthopaedics, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing, China
| | - Wei Yuan
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Ming Lu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu-Feng Liu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu-Jie Liu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
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Characterizing irreparable: a retrospective machine learning analysis of patients who undergo primary labral reconstruction during hip arthroscopy. J Hip Preserv Surg 2021. [DOI: 10.1093/jhps/hnab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Abstract
Hip labrum reconstruction has been demonstrated to be a viable option for patients with irreparable labral tears. However, there is a lack of data analyzing patient and labral characteristics in those undergoing primary hip labral reconstruction. To use a machine learning technique to subcategorize patients who underwent labral reconstruction during primary hip arthroscopy and to determine if there may be varying pathology resulting in severe labral damage. Patients who underwent primary labral reconstruction between 2015 and 2018 were included. Patients with a prior ipsilateral hip surgery, who were unwilling to participate, or had incomplete preoperative data were excluded. Agglomerative hierarchical clustering analysis was conducted to identify the subgroups of patients. A comparison was performed for preoperative characteristics, intraoperative findings and procedures. Of the 191 patients who underwent primary labral reconstruction and were eligible, 174 were included in the clustering analysis. Two distinct groups were identified (Group 1: 112 patients, 64.4%; Group 2: 62 patients, 35.6%). Group 1 had a significantly higher proportion of females (61.6% versus 43.5%; P < 0.05), combined Seldes I and II labral tears (94.6% versus 54.8%; P < 0.05), and larger tears. Group 2 had a significantly higher rate of labral calcification (82.3% versus 3.6%; P < 0.05). The results of this study demonstrate two distinct groups of patients who underwent primary hip labral reconstruction: those with severe labral damage, and those with a calcified labrum. Approximately two-thirds were placed in the group with severe labral damage, while the other third had diminished quality secondary to calcific changes. Retrospective comparative trial; Level of Evidence, 3.
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Soriano KKJ, Flores SE, Aung MS, Nguyen TQ, Zhang AL. Treatment of Labral Calcification in the Setting of Femoroacetabular Impingement Syndrome With Arthroscopic Calcification Excision, Labral Repair, and Osteoplasty Improves Outcomes. Arthroscopy 2021; 37:554-563. [PMID: 33122106 DOI: 10.1016/j.arthro.2020.10.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the diagnosis and 2-year outcomes of arthroscopic treatment for labral calcification in the setting of femoroacetabular impingement syndrome (FAIS). METHODS A retrospective analysis was performed from a prospectively collected database of patients with FAIS undergoing hip arthroscopy. Patients with FAIS with labral calcification were differentiated radiographically from patients with other paralabral radiopaque densities such as os acetabuli, acetabular rim fractures, and labral ossification. Patients with FAIS with labral calcification were treated with arthroscopic calcification excision, labral repair, and osteoplasty and matched by age, sex, and body mass index with a cohort of patients with FAIS without labral calcifications who underwent labral repair and osteoplasty. Pre- and 2 years postoperatively, patients completed patient-reported outcome (PRO) scores including the modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey, and visual analog scale. RESULTS In total, 40 hips (21 male, 19 female) with FAIS and labral calcification were included (age 36.8 ± 8.1, body mass index, 25.9 ± 4.5). Patients with FAIS with labral calcification demonstrated similar significant PRO score improvements compared with a matched cohort of patients with FAIS without labral calcification at 2 years after surgery (visual analog scale: (-)2.3 ± 0.4, (-)2.7 ± 0.5, modified Harris Hip Score: 16.1 ± 2.6, 17.1 ± 3.2; HOOS symptoms: 21.9 ± 3.7, 18.6 ± 3.6; HOOS pain: 22.1 ± 3.0, 25.0 ± 3.5; HOOS activities of daily living: 20.2 ± 2.8, 23.8 ± 3.3; HOOS sport: 35.6 ± 5.0, 35.6 ± 4.1; HOOS quality of life: 36.9 ± 4.5, 37.5 ± 4.4; 12-item Short-Form survey physical component summary: 15.5 ± 2.3, 20.1 ± 2.1, respectively). Both cohorts achieved minimal clinically important differences at equivalent rates (60%-82.5%) for all PRO scores. CONCLUSIONS Patients with labral calcification in the setting of FAIS can be effectively treated with arthroscopic calcification excision, labral repair, and osteoplasty. These patients demonstrate significant improvements in patient-reported outcomes and achievement of minimal clinically important differences at 2 years similar to patients undergoing arthroscopic treatment for FAIS without labral calcification. LEVEL OF EVIDENCE Level III, matched cohort study.
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Affiliation(s)
- Kylen K J Soriano
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Sergio E Flores
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Mya S Aung
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Thu Quynh Nguyen
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A..
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Zhong M, Ouyang K, Lu W. Letter to the editor: Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement. J Orthop Surg Res 2020; 15:218. [PMID: 32532303 PMCID: PMC7291579 DOI: 10.1186/s13018-020-01744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mingjin Zhong
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China. .,The Second People's Hospital of Shenzhen, No.3002 Sungang West Road, Futian district, Shenzhen, 518000, Guangdong province, China.
| | - Kan Ouyang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China.,The Second People's Hospital of Shenzhen, No.3002 Sungang West Road, Futian district, Shenzhen, 518000, Guangdong province, China
| | - Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China.,The Second People's Hospital of Shenzhen, No.3002 Sungang West Road, Futian district, Shenzhen, 518000, Guangdong province, China
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Jones DM, Crossley KM, Ackerman IN, Hart HF, Dundules KL, O'Brien MJ, Mentiplay BF, Heerey JJ, Kemp JL. Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:7. [PMID: 31993831 PMCID: PMC6987281 DOI: 10.1186/s40798-020-0234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
Background Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence Level IV, systematic review of Level 2 through to Level 4 studies
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Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - Karen L Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J O'Brien
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Konyves A. Editorial Commentary: Be on the Lookout for White Chalk! Hip Labrum Calcification. Arthroscopy 2018; 34:1234-1235. [PMID: 29622258 DOI: 10.1016/j.arthro.2017.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 02/02/2023]
Abstract
Amorphous calcification of the hip labrum is a little known and relatively rare condition. Although patients with amorphous calcification have favorable post-arthroscopic surgery self-reported outcome, it is unclear how much of their improvement can be attributed to the debridement of the calcific lesion itself.
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