Hip-Femoral Acetabular Impingement

The Effect of Hip Joint Mobilizations Using a Mobilization Belt on Hip Range of Motion and Functional Outcomes

CONTEXT

Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip.

OBJECTIVE

To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol.

DESIGN

A prospective exploratory study.

SETTING

Two research labs.

PATIENTS OR OTHER PARTICIPANTS

The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg).

INTERVENTIONS

Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week.

MAIN OUTCOMES MEASURES

Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test.

RESULTS

A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM.

CONCLUSION

Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.

Shape variability of the adult human acetabulum and acetabular fossa related to sex and age by geometric morphometrics. Implications for adult age estimation

This study aims to explore shape variability of the acetabulum during the human adult life span, in relation to sex and age. The human acetabular shape was analysed in 682 os coxae from three different documented skeletal collections from the Iberian Peninsula. Two landmarks and thirty-two sliding semi-landmarks were used for the geometric morphometric procedures and a clock-wise standard was used for orientation. The 180° meridian (6:00) line was positioned over the midpoint of the acetabular notch and 36 reference points in 10° increments along the rim were marked. Data showed that size, sex and age significantly influence acetabular shape variation. Sex differences were significant in individuals younger than 65 years old and were characterised by males exhibiting relatively extended acetabular rim profiles from 10:00 to 1:00, narrower acetabular notches, and reduced acetabular fossae. In addition, three main age-related changes occurred to the acetabular shape in both sexes: outer acetabular profile modification, with extension from 10:00 to 1:00 and reduction from 7:00 to 9:00, acetabular notch narrowing, and acetabular fossa reduction. The age-related changes that were observed are shared by both sexes and seem to be related to bone production associated with age. Specifically, age appears to affect the entire border of the lunate surface: the acetabular rim, both acetabular horns, and the outer edge of the acetabular fossa. Furthermore, shape data confirmed the clover-leaf shape of the acetabular fossa in both males and females. These results improve our understanding of acetabular shape, and assist in refining age-estimation methods and enhancing hip surgery and rehabilitation.

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

BACKGROUND

There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI).

PURPOSE

To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 2.

METHODS

A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?"

RESULTS

There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values-at which patients considered their status to be satisfactory-at 1 year after surgery were 74 (mHHS), 87 (HOS-activities of daily living subscale), and 75 (HOS-sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS-activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS.

CONCLUSION

This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI.

Groin pain in athletes: a novel diagnostic approach

Groin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem.