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González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [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: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
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Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
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Lewis CL, Shefelbine SJ. Lost in research translation: Female athletes are not male athletes, especially at the hip. J Orthop Res 2024. [PMID: 38644357 DOI: 10.1002/jor.25860] [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: 12/05/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
Altered shape of the proximal femur (cam morphology) or acetabulum (pincer morphology) is indicative of femoroacetabular impingement, which can result in hip pain and osteoarthritis of the hip. As mechanical load during growth affects the resulting bone shape, there is strong evidence in males that cam morphology develops during skeletal growth while physes are open, rather than as an adaptation after growth plates are closed (skeletal maturity). This adaptation is particularly evident in athletes who participate at elite levels prior to skeletal maturity. The research providing this evidence, however, has primarily focused on male athletes. Despite the lack of inclusion in the research, females consistently comprise two thirds of the clinical and surgical populations with structural hip pain or pathology. Knowledge gained from male-dominated cohorts may not appropriately transfer to female athletes, especially at the hip. This perspectives article briefly reviews differences between females and males in femoral and acetabular structure, hormones, timing of puberty/maturation, hypermobility, activity level and movement control-factors which affect hip structure development and loading. Without female-focused research, the application of research findings from male athletes to female athletes may lead to ineffective or even inappropriate recommendations and treatments. Thus, there is a critical need for investment in research to promote life-long hip health for females.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering and Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
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Enseki KR, Bloom NJ, Harris-Hayes M, Cibulka MT, Disantis A, Di Stasi S, Malloy P, Clohisy JC, Martin RL. Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision. J Orthop Sports Phys Ther 2023; 53:CPG1-CPG70. [PMID: 37383013 DOI: 10.2519/jospt.2023.0302] [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: 06/30/2023]
Abstract
The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.
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Hilfiker R, Hunkeler M, Limacher A, Leunig M, Bonel H, Egger M, Jüni P, Reichenbach S. Is Internal Rotation Measurement of the Hip Useful for Ruling in Cam or Pincer Morphology in Asymptomatic Males? A Diagnostic Accuracy Study. Clin Orthop Relat Res 2022; 480:1989-1998. [PMID: 35700433 PMCID: PMC9473784 DOI: 10.1097/corr.0000000000002244] [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] [Received: 10/05/2021] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cam and pincer morphologies are associated with limited internal rotation. However, the routine clinical examination for hip rotation has limited reliability. A more standardized method of measuring hip rotation might increase test-retest and interobserver reliability and might be useful as a screening test to detect different hip morphologies without the need for imaging. We developed an examination chair to standardize the measurement of internal hip rotation, which improved interobserver reliability. However, the diagnostic test accuracy for this test is unknown. QUESTION/PURPOSE Is a standardized method of determining internal hip rotation using an examination chair useful in detecting cam and pincer morphology with MRI as a reference standard? METHODS A diagnostic test accuracy study was conducted in a sample of asymptomatic males. Using an examination chair with a standardized seated position, internal rotation was measured in 1080 men aged 18 to 21 years who had been conscripted for the Swiss army. The chair prevents compensatory movement by stabilizing the pelvis and the thighs with belts. The force to produce the internal rotation was standardized with a pulley system. Previous results showed that the measurements with the examination chair are similar to clinical assessment but with higher interobserver agreement. A random sample of 430 asymptomatic males was invited to undergo hip MRI. Of those, 244 White European males responded to the invitation and had a mean age of 20 ± 0.7 years and a mean internal rotation of the hip of 33° ± 8.5°. Using MRI as the reference standard, 69% (169 of 244) had a normal hip, 24% (59 of 244) a definite cam morphology (Grades 2 and 3), 3% (8 of 244) an increased acetabular depth, and 3% (8 of 244) a combination of both. One experienced radiologist graded cam morphology as follows: 0 = normal, 1 = mild, 2 = moderate, and 3 = severe. Pincer morphology was defined by increased acetabular depth (≤ 3 mm distance between the center of the femoral neck and the line connecting the anterior and posterior acetabular rims). The intraobserver agreement was substantial (weighted κ of 0.65). A receiver operating characteristic (ROC) curve was fitted, and sensitivity, specificity, and likelihood ratios were estimated for different internal rotation cutoffs. RESULTS For cam morphology, the area under the ROC curve was 0.75 (95% CI 0.67 to 0.82). Internal hip rotation of less than 20° yielded a positive likelihood ratio of 9.57 (sensitivity 0.13, specificity 0.99), and a value of 40° or more resulted in a negative likelihood ratio of 0.36 (sensitivity 0.93, specificity 0.20). The area under the curve for detecting the combination of cam and pincer morphologies was 0.87 (95% CI 0.74 to 1.0). A cutoff of 20° yielded a positive likelihood ratio of 9.03 (sensitivity 0.33, specificity 0.96). CONCLUSION This examination chair showed moderate-to-good diagnostic value to rule in hip cam morphology in White European males. However, at the extremes of the 95% confidence intervals, diagnostic performance would be poor. Nonetheless, we believe this test can contribute to identifying cam morphologies, and we hope that future, larger studies-ideally in more diverse patient populations-will seek to validate this to arrive at more precise estimates of the diagnostic performance of this test. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Roger Hilfiker
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marc Hunkeler
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | | | - Harald Bonel
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Switzerland
- Campus Stiftung Lindenhof, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Uquillas CA, Sun Y, Van Sice W, ElAttrache NS, Banffy MB. Prevalence of femoroacetabular impingement in elite baseball players. J Hip Preserv Surg 2022; 9:145-150. [PMID: 35992028 PMCID: PMC9389915 DOI: 10.1093/jhps/hnac034] [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: 12/29/2021] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.
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Affiliation(s)
- Carlos A Uquillas
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Yuhang Sun
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Wade Van Sice
- Kerlan Jobe Orthopedic Clinic, 2055 Military Trail #204 , Jupiter, FL 33458, USA
| | - Neal S ElAttrache
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Michael B Banffy
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
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Verhaegen JC, Innmann M, Alves Batista N, Dion CA, Horton I, Pierrepont J, Merle C, Grammatopoulos G. Defining "Normal" Static and Dynamic Spinopelvic Characteristics: A Cross-Sectional Study. JB JS Open Access 2022; 7:e22.00007. [PMID: 35812809 PMCID: PMC9260734 DOI: 10.2106/jbjs.oa.22.00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Spinopelvic characteristics influence the hip's biomechanical behavior. However, there is currently little knowledge regarding what "normal" characteristics are. This study aimed to determine how static and dynamic spinopelvic characteristics change with age, sex, and body mass index (BMI) among well-functioning volunteers. Methods This was a cross-sectional cohort study of 112 asymptomatic volunteers (age, 47.4 ± 17.7 years; 50.0% female; BMI, 27.3 ± 4.9 kg/m2). All participants underwent lateral spinopelvic radiography in the standing and deep-seated positions to determine maximum hip and lumbar flexion. Lumbar flexion (change in lumbar lordosis, ∆LL), hip flexion (change in pelvic-femoral angle, ∆PFA), and pelvic movement (change in pelvic tilt, ΔPT) were determined. The hip user index, which quantifies the relative contribution of the hip to overall sagittal movement, was calculated as (∆PFA/[∆PFA + ∆LL]) × 100%. Results There were decreases of 4.5° (9%) per decade of age in lumbar flexion (rho, -0.576; p < 0.001) and 3.6° (4%) per decade in hip flexion (rho, -0.365; p < 0.001). ∆LL could be predicted by younger age, low standing PFA, and high standing LL. Standing spinopelvic characteristics were similar between sexes. There was a trend toward men having less hip flexion (90.3° ± 16.4° versus 96.4° ± 18.1°; p = 0.065) and a lower hip user index (62.9% ± 8.2% versus 66.7% ± 8.3%; p = 0.015). BMI weakly correlated with ∆LL (rho, -0.307; p = 0.011) and ∆PFA (rho, -0.253; p = 0.039). Conclusions Spinopelvic characteristics were found to be age, sex, and BMI-dependent. The changes in the lumbar spine during aging (loss of lumbar lordosis and flexion) were greater than the changes in the hip, and as a result, the hip's relative contribution to overall sagittal movement increased. Men had a greater change in posterior pelvic tilt when moving from a standing to a deep-seated position in comparison with women, secondary to less hip flexion. The influence of BMI on spinopelvic parameters was low.
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Affiliation(s)
- Jeroen C.F. Verhaegen
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
- University Hospital Antwerp, Edegem, Belgium
| | - Moritz Innmann
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Orthopaedics and Trauma Surgery, Heidelberg University, Heidelberg, Germany
| | - Nuno Alves Batista
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Charles-Antoine Dion
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabel Horton
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, Heidelberg University, Heidelberg, Germany
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
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Mid-term outcomes of exercise therapy for the non-surgical management of femoroacetabular impingement syndrome: are short-term effects persisting? Phys Ther Sport 2022; 55:168-175. [DOI: 10.1016/j.ptsp.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
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Buzin S, Shankar D, Vasavada K, Youm T. Hip Arthroscopy for Femoroacetabular Impingement-Associated Labral Tears: Current Status and Future Prospects. Orthop Res Rev 2022; 14:121-132. [PMID: 35480069 PMCID: PMC9037737 DOI: 10.2147/orr.s253762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/02/2022] [Indexed: 12/03/2022] Open
Abstract
Femoroacetabular impingement (FAI) has emerged as a common cause of hip pain, especially in young patients. While the exact cause of FAI is unknown, it is thought to result from repetitive microtrauma to the proximal femoral epiphysis leading to abnormal biomechanics. Patients typically present with groin pain that is exacerbated by hip flexion and internal rotation. Diagnosis of FAI is made through careful consideration of patient presentation as well as physical exam and diagnostic imaging. Use of radiographs can help diagnose both cam and pincer lesions, while the use of MRI can diagnose labral tears and cartilage damage associated with FAI. Both non-operative and surgical options have their role in the treatment of FAI and its associated labral tears; however, hip arthroscopy has had successful outcomes when compared with physical therapy alone. Unfortunately, chondral lesions associated with FAI have had poorer outcomes with a higher conversion rate to arthroplasty. Capsular closure following hip arthroscopy has shown superior clinical outcomes and therefore should be performed if possible. More recently, primary labral reconstruction has emerged in the literature as a good option for irreparable labral tears. While non-operative management may have its role in treating patients with FAI, hip arthroscopy has developed a successful track record in being able to treat cam and pincer lesions, chondral damage, and labral injuries.
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Affiliation(s)
- Scott Buzin
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Dhruv Shankar
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kinjal Vasavada
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Youm
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
- Correspondence: Thomas Youm, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA, Tel +1 212-348-3636, Email
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9
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Vasavada K, Ross KA, Lott A, Shankar D, Marulanda D, Mojica ES, Carter CW, Borowski L, Gonzalez-Lomas G. Characterizing femoroacetabular impingement in professional Nordic Skiers. PHYSICIAN SPORTSMED 2022; 51:285-290. [PMID: 35324395 DOI: 10.1080/00913847.2022.2056770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Studies have shown a high prevalence of femoroacetabular impingement (FAI) among elite athletes yet there is a paucity of data on FAI in Nordic skiers. The purpose of this study was to determine the prevalence of radiographic FAI in professional Nordic Combined Skiers and Ski jumpers compared to controls and assess functional outcomes including hip range of motion (ROM) and pain in patients with radiographic evidence of FAI compared to those without it. METHODS A cohort of elite Nordic Skiers underwent medical history, physical examination, and pelvic radiographs at their visit with a fellowship-trained sports medicine physician. On pelvis radiographs, Alpha angle>55 degrees was deemed cam-positive, and positive crossover signs, Tönnis<0, or LCEA>40 were deemed pincer positive. Further stratification was performed by sex, ski event type, hip pain, presence of cam lesions, and presence of pincer lesions. Spearman correlation matrix was performed to measure the association between radiographic measurements and ROM. RESULTS Nineteen Nordic skiers and nineteen age, sex, and BMI matched controls were included in the study. There were no significant differences in age, sex, BMI, and hip pain between groups. While Nordic skiers demonstrated decreased ROM bilaterally on external rotation compared to controls, skiers had larger ROM bilaterally on extension, abduction, adduction compared to controls. Skiers were significantly more likely to have bilateral crossover sign and alpha angles>55 compared to controls. Subgroup analysis showed that Cam positive patients had higher flexion and adduction ROM and pincer positive patients had significantly higher flexion and abduction ROM compared to patients without cam and pincer lesions respectively. Patients with hip pain had significantly lower right hip abduction ROM compared to patients without hip pain. No significant correlations were seen between radiographic measurements and ROM. CONCLUSION Similar to other elite 'hip heavy' sport athletes, Nordic skiers gave a notably higher prevalence of radiographic cam and pincer type morphology and significantly higher ROM compared to nonathletic controls. Clinicians evaluating Nordic skiers should be aware of these baseline findings with respect to a possible elevated long-term risk of symptomatic FAI in these athletes as well as other conditions related to radiographic FAI.
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Affiliation(s)
- Kinjal Vasavada
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Keir Alexander Ross
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Dhruv Shankar
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - David Marulanda
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Cordelia W Carter
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Lauren Borowski
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
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10
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[Imaging in joint-preserving hip surgery]. Radiologe 2022; 62:271-284. [PMID: 35238995 PMCID: PMC8894169 DOI: 10.1007/s00117-022-00973-0] [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] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
Instabilität und Impingement stellen die Hauptpathomechanismen dar, die bereits bei jungen Patienten durch erhöhten mechanischen Stress zu chondrolabralen Schäden, schmerzhafter Bewegungseinschränkung und frühzeitiger Coxarthrose führen können. Ziele der gelenkerhaltenden Chirurgie an der Hüfte sind die Korrektur der knöchernen Deformitäten und chondrolabraler Schäden sowie die Wiederherstellung der Gelenkfunktion. Voraussetzung dafür ist die Identifikation der ursächlichen Pathologien an der Hüfte, welche zudem in Kombination auftreten können. Die dezidierte Röntgen- und Magnetresonanzbildgebung der knöchernen Morphologie und der degenerativen Gelenkbinnenläsionen liefern einen essenziellen Beitrag für die Behandlungsindikation und die Behandlungsplanung. Der vorliegende Artikel soll einen kurzen Überblick über die Hüftdeformitäten mit deren Prävalenz, Pathomechanismus und indizierter Therapie sowie detaillierte Empfehlungen über die spezifische radiologische Abklärung geben.
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11
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Steppacher SD, Meier MK, Albers CE, Tannast M, Siebenrock KA. Acetabular Cartilage Thickness Differs Among Cam, Pincer, or Mixed-Type Femoroacetabular Impingement: A Descriptive Study Using In Vivo Ultrasonic Measurements During Surgical Hip Dislocation. Cartilage 2021; 13:465S-475S. [PMID: 33550853 PMCID: PMC8804723 DOI: 10.1177/1947603521990879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate acetabular cartilage thickness among (1) 8 measurement locations on the lunate surface and (2) different types of femoroacetabular impingement (FAI). DESIGN Prospective descriptive study comparing in vivo measured acetabular cartilage thickness using a validated ultrasonic device during surgical hip dislocation in 50 hips. Measurement locations included the anterior/posterior horn and 3 locations on each peripheral and central aspect of the acetabulum. The clock system was used for orientation. Thickness was compared among cam (11 hips), pincer (8 hips), and mixed-type (31 hips) of FAI. Mean age was 31 ± 8 (range, 18-49) years. Hips with no degenerative changes were included (Tönnis stage = 0). RESULTS Acetabular cartilage thickness ranged from 1.7 mm to 2.7 mm and differed among the 8 locations (P < 0.001). Thicker cartilage was found on the peripheral aspect at 11 and 1 o'clock positions (mean of 2.4 mm and 2.7 mm, respectively). At 5 out of 8 locations of measurement (anterior and posterior horn, 1 o'clock peripheral, 12 and 2 o'clock central), cartilage thickness was thinner in hips with pincer impingement compared to cam and/or mixed-type of FAI (P ranging from <0.001 to 0.031). No difference in thickness existed between cam and mixed-type of impingement (P = 0.751). CONCLUSION Acetabular cartilage thickness varied topographically and among FAI types. This study provides first baseline information about topographical cartilage thickness in FAI measured in vivo. Thinner cartilage thickness in pincer deformities could be misinterpreted as joint degeneration and could therefore have an impact on indication for hip preserving surgery.
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Affiliation(s)
- Simon Damian Steppacher
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Malin Kristin Meier
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland,Malin Kristin Meier, Department of
Orthoapedic Surgery and Traumatology, Inselspital, Bern University Hospital,
University of Bern, Freiburgstrasse, Bern 3010, Switzerland.
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and
Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg,
Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
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12
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Hip Arthroscopy Volume and Reoperations in a Large Cross-Sectional Population: High Rate of Subsequent Revision Hip Arthroscopy in Young Patients and Total Hip Arthroplasty in Older Patients. Arthroscopy 2021; 37:3445-3454.e1. [PMID: 33901509 DOI: 10.1016/j.arthro.2021.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report contemporary trends in hip arthroscopy case volume in the United States using a large cross-sectional cohort with accurate laterality tracking for assessment of revision surgery and rates of conversion to total hip arthroplasty (THA). METHODS Using Current Procedural Terminology codes, we queried the Mariner PearlDiver dataset for patients who underwent hip arthroscopy from 2010 to 2017. Patient demographics were recorded and subsequent hip arthroscopy procedures and THA conversion within 2 years after surgery were tracked using International Classification of Diseases, Tenth Revision codes to accurately identify laterality. Emergency department and hospital admission within 30 days after surgery were queried. RESULTS Of the 53,103 patients undergoing hip arthroscopy procedures, hip arthroscopy case volume increased 2-fold from 2010 to 2014 but remained relatively unchanged from 2014 to 2017. The most common age group undergoing surgery was 40 to 49 years, and female patients represented 70% of cases. Two-year subsequent surgery rate was 19%, with 15.1% undergoing a revision arthroscopy and 3.9% converting to THA. The most common revision arthroscopy procedures were femoroplasty (9.5%), labral repair (8.5%), and acetabuloplasty (4.3%). Younger patients were more likely to undergo revision arthroscopy (18% age 10-19 years; 15% age 20-29 years). Older patients had a significant risk for conversion to THA within 2 years (36% age 60-69 years; 28% age 50-59 years). Female patients also demonstrated a slightly greater rate of conversion to THA (4.1% female, 3.5% male, P <.0001). Patients 20 to 29 years had the greatest risk of emergency department admission (5.4%) and hospital admission (0.8%) within 30 days of surgery. CONCLUSIONS The rise in hip arthroscopy procedures may be starting to plateau in the United States. Cross-sectional data also indicate that there is a greater than previously reported rate of revision hip arthroscopy in patients younger than 30 years of age and conversion to THA in patients older than 50 years of age. LEVEL OF EVIDENCE III, cross-sectional study.
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A three-dimensional measurement method on MR arthrography of the hip to classify femoro-acetabular impingement. Jpn J Radiol 2021; 39:1175-1185. [PMID: 34181177 PMCID: PMC8639539 DOI: 10.1007/s11604-021-01162-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/20/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE (1) To investigate correlations between different types of FAI and the ratio of acetabular volume (AV) to femoral head volume (FV) on MR arthrography. (2) To assess 2D/3D measurements in identifying different types of FAI by means of cut-off values of AV/FV ratio (AFR). MATERIALS AND METHODS Alpha angle, cranial acetabular version, acetabular depth, lateral center edge angle, AV, and FV of 52 hip MR arthrography were measured. ANOVA test correlated different types of FAI with AFR. ROC curves classified FAI by cut-off values of AFR. Accuracy of 2D/3D measurements was calculated. RESULTS ANOVA test showed a significant difference of AFR (p value < 0.001) among the three types of FAI. The mean values of AFR were 0.64, 0.74, and 0.89 in cam, mixed, and pincer types, respectively. Cut-off values of AFR were 0.70 to distinguish cam types from mixed and pincer types, and 0.79 to distinguish pincer types from cam and mixed types. Cut-off values identified 100%, 73.9%, and 55.6% of pincer, cam, and mixed types. 2D and 3D classifications of FAI showed accuracy of 40.4% and 73.0%. CONCLUSIONS 3D measurements were clearly more accurate than 2D measurements. Distinct cut-off values of AFR discriminated cam types from pincer types and identified pincer types in all cases. Cam and mixed types were not accurately recognized.
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Zhou J, Melugin HP, Hale RF, Song BM, Okoroha KR, Levy BA, Krych AJ. Sex differences in the prevalence of radiographic findings of structural hip deformities in patients with symptomatic femoroacetabular impingement. J Hip Preserv Surg 2021; 8:233-239. [PMID: 35414956 PMCID: PMC8994108 DOI: 10.1093/jhps/hnab050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/23/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to determine the sex differences in the overall prevalence of radiographic femoroacetabular impingement (FAI) deformity patients presenting with hip pain and to identify the most common radiographic findings in male and female patients. A geographic database was used to identify patients between the age of 14 and 50 years with hip pain from 2000 to 2016. A chart and radiographic review was performed to identify patients with cam, pincer and mixed-type FAI. A total of 374 (449 hips) out of 612 (695 hips) male patients and 771 (922 hips) out of 1281 (1447 hips) female patients had radiographic features consistent with FAI. Ninety-four male hips (20.9%) and 45 female hips (4.9%) had cam type, 20 male hips (4.5%) and 225 female hips (24.4%) had pincer type and 335 male hips (74.6%) and 652 female hips (70.7%) had mixed type. The overall prevalence of radiographic findings consistent with FAI in male and female patients with hip pain was 61.1% and 60.2%, respectively. Mixed type was the most prevalent. The most common radiographic finding for cam-type FAI was an alpha angle >55°, and the most common radiographic finding for pincer-type FAI was a crossover sign. Male patients were found to have a higher prevalence of cam-type deformities, whereas female patients were found to have a higher prevalence of pincer-type deformities.
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Affiliation(s)
- Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 296 Shizi St, Cang Lang Qu, Suzhou, Jiangsu, China
| | - Heath P Melugin
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Rena F Hale
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Bryant M Song
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Sun Y, Thompson KA, Darden C, Youm T. Surgical Intervention for Femoroacetabular Impingement Can Lead to Improvements in Both Hip and Back Function in Patients With Coexisting Chronic Back Pain at 1-Year Follow-Up. Arthroscopy 2021; 37:1163-1169.e1. [PMID: 33278528 DOI: 10.1016/j.arthro.2020.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether patients with coexisting lumbar back pain experience back pain improvement after undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS An institutional review board-approved retrospective chart review compared patients undergoing hip arthroscopy for FAI with lumbar spine back pain to patients solely reporting hip pain. The modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 1-year follow up. The Oswestry Disability Index score, which quantifies disability from lower back pain, and visual analog scale were recorded from the hip-spine cohort alone. Statistical analysis was performed using paired sample t tests with P ≤ .05 considered significant. RESULTS Sixty-eight patients who underwent hip arthroscopy between November 2016 and October 2018 were enrolled. Thirty-four patients with a mean age of 48.2 ± 14.0 years and body mass index of 26.6 ± 6.6 had a history of back pain and 34 patients were age- and sex-matched for the matched-control (MC) cohort. The MC cohort had lower mHHS and NAHS scores preoperatively. The MC cohort reported a larger increase in the mHHS (P = .01) and NAHS scores (P = .01) postoperatively. More patients in the MC cohort reached minimally clinically important difference with mHHS (P = .003) and NAHS (P = .06). Following surgery, the hip-spine cohort reported a lower Oswestry Disability Index score, indicating minimal disability (P = .01). CONCLUSIONS Surgical intervention for FAI can lead to improvements in hip and back pain in patients with coexisting lumbar pathology. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Yuhang Sun
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - Kamali A Thompson
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A..
| | - Christon Darden
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
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Franken L, Goronzy J, Olusile OO, Slullitel PA, Blum S, Nowotny J, Hartmann A, Thielemann F, Günther KP. [Femoral neck stress fractures and femoroacetabular impingement : A retrospective case study and literature review]. DER ORTHOPADE 2021; 50:224-236. [PMID: 32346780 DOI: 10.1007/s00132-020-03916-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) can lead to morphologic damage of both the acetabulum and the femoral neck. Recent reports have found an association between impingement deformities and the development of femoral neck stress fractures. The aim of this study was to report a series of patients with these findings and to update the current evidence on the topic. MATERIAL AND METHODS 5 patients (6 cases) with atraumatic femoral neck fractures and FAI were identified in the Dresden hip registry from 2015 to 2018. Demographic data, comorbidities, radiographic results and bone metabolism results were described. A literature search was conducted using keywords related to femoral neck stress fractures and FAI syndrome. RESULTS The average age of the series was 39 (range: 22-52), 2 patients were female and 3 male. A total of 12 surgical procedures were performed. 4 of the 5 patients showed radiographic features of pincer and/or cam-FAI, whereas 3 patients had a decreased femoral antetorsion (-7° to +7° antetorsion). In 3 patients, magnetic resonance imaging revealed additional signs of avascular necrosis ARCO I. There was a lack of FAI-specific treatment recommendations in the available literature. DISCUSSION Radiographic results of the patients evaluated suggested that impingement-associated deformities of the hip may cause femoral neck stress fractures, which is in line with the available literature. This potential coincidence should be integrated in diagnostic algorithms and therapeutic approaches.
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Affiliation(s)
- Lea Franken
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Jens Goronzy
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - O O Olusile
- Department for Orthopaedic Surgery and Traumatology, University of Medical Sciences Teaching Hospital Akure/Ondo, Akure/Ondo, Nigeria
| | - Pablo Ariel Slullitel
- Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentinien
| | - Sophia Blum
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Jörg Nowotny
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Albrecht Hartmann
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Falk Thielemann
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Klaus-Peter Günther
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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17
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Morales-Avalos R, Tapia-Náñez A, Simental-Mendía M, Elizondo-Riojas G, Morcos-Sandino M, Tey-Pons M, Peña-Martínez VM, Barrera FJ, Guzman-Lopez S, Elizondo-Omaña RE, Vílchez-Cavazos F. Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes. Orthop J Sports Med 2021; 9:2325967120977892. [PMID: 33614808 PMCID: PMC7874354 DOI: 10.1177/2325967120977892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences (P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México.,Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adriana Tapia-Náñez
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México.,Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Simental-Mendía
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Guillermo Elizondo-Riojas
- Department of Radiology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Marc Tey-Pons
- Department of Orthopedic Surgery, Hospitals del Mar i l'Esperança, Barcelona, Spain
| | - Víctor M Peña-Martínez
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco J Barrera
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Santos Guzman-Lopez
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rodrigo E Elizondo-Omaña
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Félix Vílchez-Cavazos
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
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18
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Hale RF, Melugin HP, Zhou J, LaPrade MD, Bernard C, Leland D, Levy BA, Krych AJ. Incidence of Femoroacetabular Impingement and Surgical Management Trends Over Time. Am J Sports Med 2021; 49:35-41. [PMID: 33226833 PMCID: PMC8025987 DOI: 10.1177/0363546520970914] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a well-known cause of hip pain in adolescents and young adults. However, the incidence in the general population has not been clearly defined. PURPOSE To (1) define the population-based incidence of diagnosis of FAI in patients with hip pain, (2) report the trends in diagnosis of FAI over time, and (3) determine the changes in the rate and type of surgical management over time. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A geographic database was used to identify patients who were 14 to 50 years old with hip pain between the years 2000 and 2016. Chart and radiographic review was performed to determine which patients had FAI. To be included, patients had to have a triad of clinical symptoms, physical examination signs, and imaging findings consistent with FAI. Medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Statistical analysis determined the overall age- and sex-adjusted annual incidence of FAI diagnosis and trends over time. RESULTS There were 1893 patients evaluated with hip pain, and 716 (38%; 813 hips) had diagnosed FAI. The mean ± SD age was 27.2 ± 8.4 years, and 67% were female. The incidence of FAI diagnosis was 54.4 per 100,000 person-years. Female patients had a higher incidence than male patients (73.2 vs 36.1 per 100,000 person-years; P < .01). Incidence of FAI diagnosis were higher from 2010 to 2016 (72.6 per 100,000 person-years; P < .01) as compared with 2005 to 2009 (45.3) and 2000 to 2004 (40.3). Hip arthroscopy, surgical hip dislocation, and periacetabular osteotomy utilization increased from the 2000-2004 to 2010-2016 periods, respectively: 1 (1%) to 160 (20%; P = .04), 2 (1%) to 37 (5%; P = .01), and 1 (1%) to 22 (3%; P = .58). CONCLUSION The overall incidence of FAI diagnosis was 54.4 per 100,000 person-years, and it consistently increased between 2000 and 2016. Female patients had a higher incidence than male patients. The utilization of joint preservation operations, including hip arthroscopy, surgical hip dislocation, and anteverting periacetabular osteotomy, increased over time.
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Affiliation(s)
- Rena F. Hale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Heath P. Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Matthew D. LaPrade
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Devin Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,Address correspondence to Aaron J. Krych, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA ()
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van Klij P, Reiman MP, Waarsing JH, Reijman M, Bramer WM, Verhaar JAN, Agricola R. Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values. Orthop J Sports Med 2020; 8:2325967120938312. [PMID: 32844100 PMCID: PMC7418265 DOI: 10.1177/2325967120938312] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use. Purpose To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology. Study Design Systematic review; Level of evidence, 3. Methods The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion. Results We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported. Conclusion Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, Naal FD. Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness. Arthritis Care Res (Hoboken) 2019; 71:1074-1083. [PMID: 30133164 DOI: 10.1002/acr.23728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/14/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the responsiveness to exercise therapy of patients with femoroacetabular impingement syndrome (FAIS), and to investigate differences in hip function, strength, and morphology between responders versus nonresponders. METHODS Patients with FAIS underwent 12 weeks of semi-standardized and progressive exercise therapy. A good therapy outcome (responders) versus a poor therapy outcome (nonresponders) was determined at week 18 with the Global Treatment Outcome questionnaire for hip pain. Hip function was evaluated using the Hip Outcome Score (HOS) activities of daily living (ADL) and Sport at baseline, and at weeks 6, 12, and 18. Hip muscle strength and dynamic pelvic control were evaluated using dynamometry and video analysis, respectively, at baseline, week 12, and week 18. Hip morphology was evaluated with imaging at baseline. RESULTS Thirty-one patients (mean age 24 years) were included. Sixteen patients (52%) were responsive and 15 patients (48%) were not responsive to exercise therapy. Only responders improved HOS ADL and HOS Sport by 10 points (95% confidence interval [95% CI] 7, 14; P < 0.001) and by 20 points (95% CI 15, 25; P < 0.001), respectively, and hip abductor strength by 0.27 Nm/kg (95% CI 0.18, 0.36; P < 0.001). The prevalence of patients showing good dynamic pelvic control only increased in responders (44%; P = 0.029). The prevalence of severe cam morphology was higher in nonresponders than in responders (40% versus 6%; P = 0.037). CONCLUSION Half of patients with FAIS benefit from exercise therapy in the short term. Responsiveness to hip abductor strength and dynamic pelvic control improvements is associated with a good therapy outcome, whereas the presence of severe cam morphology is associated with a poor therapy outcome.
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Affiliation(s)
- Nicola C Casartelli
- Schulthess Clinic and Laboratory of Exercise and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Reto Sutter
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
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21
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Bieri M, Beck M, Limacher A, Wyatt MC, Leunig M, Jüni P, Reichenbach S. Increased subchondral bone thickness in hips with cam-type femoroacetabular impingement. Hip Int 2019; 29:430-437. [PMID: 30560696 DOI: 10.1177/1120700018808996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Increased thickness of subchondral acetabular bone with associated articular cartilage thinning in hips with femoroacetabular (FAI) cam impingement has been observed on magnetic resonance imaging (MRI). Dynamic attrition by the cam deformity moving into the acetabulum may potentiate trans-articular shear stresses thus causing these subchondral bone changes. We aimed to quantify the hypertrophic changes of subchondral acetabular bone in patients with cam-type FAI. METHODS MRI studies were performed on an asymptomatic population of young Swiss army recruits. Subjects underwent clinical examination and completed questionnaires before undergoing an MRI of the hip. Cam deformities were graded and the dimensions of the acetabular subchondral bone quantified. Univariate linear regression was used to determine the association between the presence of cam deformities and the degree of subchondral acetabular sclerosis. RESULTS There was a strong association between cam deformities and the thickness, area and shape of subchondral sclerosis. The main increase in hypertrophy was observed in the antero-superior acetabulum where impingement typically occurs. The subchondral sclerosis was 0.66 mm thicker in cam-type deformities than in hips without cam-type deformities (95% CI, 0.38-0.93, p value < 0.001). CONCLUSIONS Mechanical stress in the antero-superior acetabular area is elevated in hips with a cam-type deformity. The study supports the concept that cam-type deformity induced stress leads to hypertrophy of subchondral acetabular bone in the area of impingement. This is collocated with the clinically observed cartilage damage caused by the cam mechanism.
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Affiliation(s)
- Martina Bieri
- 1 Clinic of Paediatrics, Luzerner Kantonsspital Luzern, Switzerland
| | - Martin Beck
- 2 Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Andreas Limacher
- 3 Clinical Trial Unit Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Michael C Wyatt
- 2 Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Michael Leunig
- 4 Schulthess Clinic, Department of Orthopaedics, Zürich, Switzerland
| | - Peter Jüni
- 5 Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Stephan Reichenbach
- 5 Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,6 Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland
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Femoroazetabuläres Impingement. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mascarenhas VV, Rego P, Dantas P, Caetano AP, Jans L, Sutter R, Marques RM, Ayeni OR, Consciência JG. Can We Discriminate Symptomatic Hip Patients From Asymptomatic Volunteers Based on Anatomic Predictors? A 3-Dimensional Magnetic Resonance Study on Cam, Pincer, and Spinopelvic Parameters. Am J Sports Med 2018; 46:3097-3110. [PMID: 30379583 DOI: 10.1177/0363546518800825] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Given the high prevalence of patients with hip deformities and no ongoing hip dysfunction, understanding the anatomic factors predicting the symptomatic state is critical. One such variable is how the spinopelvic parameters (SPPs) may interplay with hip anatomic factors. HYPOTHESIS/PURPOSE SPPs and femoral- and acetabular-specific parameters may predict which patients will become symptomatic. The purpose was to determine which anatomic characteristics with specific cutoffs were associated with hip symptom development and how these parameters relate to each other. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS 548 participants were designated either symptomatic patients (n = 176, scheduled for surgery with hip pain and/or functional limitation) or asymptomatic volunteers (n = 372, no pain) and underwent 3-dimensional magnetic resonance imaging. Multiple femoral (α angle, Ω angle, neck angle, torsion), acetabular (version, coverage), and spinopelvic (pelvic tilt, sacral slope [SS], pelvic incidence) parameters were measured semiautomatically. Normative values, optimal differentiating thresholds, and a logistic regression analysis were computed. RESULTS Symptomatic patients had larger cam deformities (defined by increased Ω angle and α angle), smaller acetabular coverage, and larger pelvic incidence and SS angles compared with the asymptomatic volunteers. Discriminant receiver operating characteristic analysis confirmed that radial 2-o'clock α angle (threshold 58°-60°, sensitivity 75%-60%, specificity 80%-84%; area under the curve [AUC] = 0.831), Ω angle (threshold 43°, sensitivity 72%, specificity 70%; AUC = 0.830), acetabular inclination (threshold 6°, sensitivity 65%, specificity 70%; AUC = 0.709), and SS (threshold 44°, sensitivity 72%, specificity 75%; AUC = 0.801) ( P < .005) were the best parameters to classify participants. When parameters were entered into a logistic regression, significant positive predictors for the symptomatic patients were achieved for SS, acetabular inclination, Ω angle, and α angle at 2-o'clock, correctly classifying 85% of cases (model sensitivity 72%, specificity 91%; AUC = 0.919). CONCLUSION Complex dynamic interplay exists between the hip and SPPs. A cam deformity, acetabular undercoverage, and increased SPP angles are predictive of a hip symptomatic state. SPPs were significant to discriminate between participants and were important in combination with other hip deformities. Symptomatic patients can be effectively differentiated from asymptomatic volunteers based on predictive anatomic factors.
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Affiliation(s)
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | | | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Bensler S, Dietrich TJ, Zubler V, Pfirrmann CWA, Sutter R. Pincer-type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement. J Magn Reson Imaging 2018; 49:1296-1303. [PMID: 30318790 DOI: 10.1002/jmri.26297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In daily routine, pincer femoroacetabular impingement (FAI) findings are often seen without a clinical diagnosis of pincer FAI. PURPOSE To assess the presence of pincer FAI MRI findings in asymptomatic volunteers with negative impingement test versus patients with clinically confirmed FAI. STUDY TYPE Case-control study. POPULATION Sixty-three asymptomatic volunteers and 63 matched patients with FAI were included. FIELD STRENGTH/ SEQUENCE A coronal T1 -weighted turbo spin-echo sequence as well as a 3D oblique transverse water-excitation true fast imaging sequence at 1.5T. ASSESSMENT The volunteers underwent standard MRI of the hip, and patients underwent MR arthrography of the symptomatic hip using the same MR sequences. Measurements of cranial acetabular version, acetabular depth, and lateral center-edge angle were performed independently by three fellowship-trained musculoskeletal radiologists. STATISTICAL TESTS Descriptive statistics, Mann-Whitney U-test, Unpaired t-test, receiver operating characteristics (ROC), Intraclass correlation coefficient (ICC). RESULTS Forty-one percent (26/63, reader 1), 32% and 37% (20 and 23/63, reader 2/3) of asymptomatic volunteers had at least one positive MR finding for pincer-FAI. Patients with pincer or mixed-type FAI had cranial retroversion of the acetabulum of -0.2° ± 7.1 (mean ± standard deviation) for reader 1 and -0.3° ± 5.5/-0.2° ± 4.8 for reader 2 / reader 3, while asymptomatic volunteers had an anteversion of 6.2° ± 6.4 (reader 1) and 3.2° ± 4.9/3.1° ± 6.5 (readers 2/3): This difference was statistically significant (P ≤ 0.002), but there was a large overlap between the groups. Acetabular depth measurements were very similar for patients with either pincer or mixed-type FAI (5.1-5.3 mm ± 3.1) and volunteers (5.2-6.1 mm ± 2.6), without a statistically significant difference (P ≤ 0.50). Lateral center-edge angle was also similar in patients with either pincer or mixed-type FAI (32.1-35.1° ± 9.1) and volunteers (30.7-33.2° ± 6.5), without a statistically significant difference (P ≤ 0.28). DATA CONCLUSION There is a large overlap in pincer-type MRI findings between patients with symptomatic FAI and asymptomatic volunteers. More than a third of volunteers exhibited at least one positive pincer-type MRI finding. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1296-1303.
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Affiliation(s)
- Susanne Bensler
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Tobias J Dietrich
- University of Zurich, Faculty of Medicine, Zurich, Switzerland.,Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Veronika Zubler
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
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The Prevalence of Cam and Pincer Morphology and Its Association With Development of Hip Osteoarthritis. J Orthop Sports Phys Ther 2018; 48:230-238. [PMID: 29548271 DOI: 10.2519/jospt.2018.7816] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Our understanding of femoroacetabular impingement syndrome is slowly improving. The number of studies on all aspects (etiology, prevalence, pathophysiology, natural history, treatment, and preventive measures) of femoroacetabular impingement syndrome has grown exponentially over the past few years. This commentary provides the latest updates on the prevalence of cam and pincer hip morphology and its relationship with development of hip osteoarthritis (OA). Cam and pincer morphology is highly prevalent in the general population and in this paper is presented for different subgroups based on age, sex, ethnicity, and athletic activity. Methodological issues in determining prevalence of abnormal hip morphology are also discussed. Cam morphology has been associated with development of hip OA, but the association between pincer morphology and hip OA is much less clear. Results from reviewed studies, as well as remaining gaps in literature on this topic, are critically discussed and put into perspective for the clinician. J Orthop Sports Phys Ther 2018;48(4):230-238. doi:10.2519/jospt.2018.7816.
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Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB, Crossley KM. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med 2018. [PMID: 29540366 DOI: 10.1136/bjsports-2017-098264] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intra-articular hip pathologies are thought to be associated with the development of hip and groin pain. A better understanding of the relationship between symptoms and imaging findings may improve the management of individuals with intra-articular hip pathologies. OBJECTIVE To undertake a systematic review and meta-analysis to determine the prevalence of intra-articular hip pathologies in individuals with and without pain. METHODS Seven electronic databases were searched in February 2017 for studies investigating the prevalence of intra-articular hip pathologies using MRI, MRA or CT. Two independent reviewers conducted the search, study selection, quality appraisal and data extraction. Meta-analysis was performed when studies were deemed homogenous, with a strength of evidence assigned to pooled results. RESULTS In general, studies were moderate to high risk of bias, with only five studies adjudged to be low risk of bias. The 29 studies reporting on the prevalence of intra-articular hip pathologies identified limited evidence of a labral tear prevalence of 62% (95% CI 47% to 75%) in symptomatic individuals, with moderate evidence identifying a labral tear prevalence of 54% (95% CI 41% to 66%) in asymptomatic individuals. Limited evidence demonstrated a cartilage defect prevalence of 64% (95% CI 25% to 91%) in symptomatic individuals, compared with moderate evidence of a cartilage defect prevalence of 12% (95% CI 7% to 21%) in asymptomatic individuals. CONCLUSION The prevalence of intra-articular hip pathologies is highly variable in both symptomatic and asymptomatic populations. The prevalence of intra-articular hip pathologies appears to be higher in symptomatic individuals. However, imaging-defined intra-articular hip pathologies are also frequently seen in asymptomatic individuals, highlighting a potential discordant relationship between imaging pathology and pain. PROSPERO REGISTRATION NUMBER CRD42016035444.
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Affiliation(s)
- 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
| | - Andrea B Mosler
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - 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
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - 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
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Anwander H, Beck M, Büchler L. Influence of evolution on cam deformity and its impact on biomechanics of the human hip joint. J Orthop Res 2018; 36:2071-2075. [PMID: 29405367 DOI: 10.1002/jor.23863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/24/2018] [Indexed: 02/04/2023]
Abstract
Anatomy and biomechanics of the human hip joint are a consequence of the evolution of permanent bipedal gait. Habitat and behaviour have an impact on hip morphology and significant differences are present even within the same biological family. The forces acting upon the hip joint are mainly a function of gravitation and strength of the muscles. Acetabular and femoral anatomy ensure an inherently stable hip with a wide range of motion. The femoral head in first human ancestors with upright gait was spherical (coxa rotunda). Coxa rotunda is also seen in close human relatives (great apes) and remains the predominant anatomy of present-day humans. High impact sport during adolescence with open physis however can activate an underlying genetic predisposition for reinforcement of the femoral neck, causing an epiphyseal extension and the formation of an osseous asphericity at the antero-superior femoral neck (cam deformity). The morphology of cam deformity is similar to the aspherical hips of quadrupeds (coxa recta), with the difference that in quadrupeds the asphericity is posterior. It has been postulated that this is due to the fact that humans bear weight on the extended leg, while quadrupeds bear weight at 90-100° flexion. The asphericity alters the biomechanical properties of the joint and as it is forced into the acetabulum leading to secondary cartilage damage. It is considered a risk factor for later development of osteoarthritis of the hip. Clinically this presents as reduced range of motion, which can be an indicator for the structural deformity of the hip. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:XX-XX, 2018.
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Affiliation(s)
- Helen Anwander
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Beck
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Lorenz Büchler
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Prevalence of asymptomatic femoroacetabular impingement in Turkey; cross sectional study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:49-53. [PMID: 29157844 PMCID: PMC6136312 DOI: 10.1016/j.aott.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/10/2017] [Accepted: 10/01/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Femoroacetabular impingement (FAI) is one of the causes of hip pain in young-adult patients. The purpose of our study is to determine the prevalence of radiological FAI findings in asymptomatic population in Turkey. METHODS Trauma patients aged 18-65 years who applied to the emergency service between September 2015 and September 2016 were retrospectively evaluated for this study. After a preliminary study and power analysis, 2152 hips of the 1076 previously asymptomatic patients were evaluated radiologically with pelvis antero-posterior and frog-leg radiographs. On radiographs of these patients; alpha angle, lateral central edge angle (LCEA), Tönnis angle (TA) and collodiaphyseal angle were measured. Alpha angle values higher than 55° were noted as cam type FAI. TA values lower than 0° or LCEA values higher than 39° were noted as pincer type FAI. LCEA values lower than 25° or TA values higher than 10° were noted as acetabular dysplasia. RESULTS Mean age of 1076 patients (602 female, 474 male) was 42.1 ± 15.6 years. The assessment showed that 15.9% of the patients had cam type, 10.6% had pincer type, 3.1% had combined type FAI and 9.3% had findings of acetabular dysplasia. The prevalence of asymptomatic FAI is significantly more in males (46%) in comparison to females (17%) in Turkey. CONCLUSION Even though FAI is considered to be a pathology associated with hip osteoarthritis; it is very common in asymptomatic population. In this respect, our study showed that prevalence of radiological FAI findings in asymptomatic adult population was 29.6% in Turkey.
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29
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Mascarenhas VV, Rego P, Dantas P, Castro M, Jans L, Marques RM, Gouveia N, Soldado F, Ayeni OR, Consciência JG. Hip shape is symmetric, non-dependent on limb dominance and gender-specific: implications for femoroacetabular impingement. A 3D CT analysis in asymptomatic subjects. Eur Radiol 2017; 28:1609-1624. [PMID: 29110047 DOI: 10.1007/s00330-017-5072-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/06/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the reference intervals (RefInt) of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in asymptomatic hips with computed tomography (CT) and determine their dependence on age, side, limb dominance and sex. METHODS We prospectively included 590 patients and evaluated 1111 hips with semi-automated CT analysis. We calculated overall, side- and sex-specific parameters for imaging signs of cam [omega and alpha angle (α°)] and pincer-type morphology [acetabular version (ACvers), lateral centre-edge angle (LCEA) and cranio-caudal coverage]. RESULTS Hip shape was symmetrical and did not depend on limb dominance. The 95% RefInt limits were sex-different for all cam-type parameters and extended beyond current abnormal thresholds. Specifically, the upper limits of RefInt for α° at 12:00, 1:30 and 3:00 o'clock positions were 56°, 70° and 58°, respectively, and 45° for LCEA. Acetabular morphology varied between age groups, with a trend toward an LCEA/ACvers increase over time. CONCLUSION Our morphometric measurements can be used to estimate normal hip morphology in asymptomatic individuals. Notably they extended beyond current thresholds used for FAI imaging diagnosis, which was most pronounced for cam-type parameters. We suggest the need to reassess α° RefInt and consider a 60° threshold for the 12:00/3:00 positions and 65-70° for other antero-superior positions. KEY POINTS • Hip shape is symmetrical regardless of limb dominance. • Pincer/cam morphology is frequent in asymptomatic subjects (20 and 71%, respectively). • LCEA and acetabular version increases with age (5-7° between opposite age groups). • Femoral morphology is stable after physeal closure (in the absence of pathology). • Alpha and omega angle thresholds should be set according to sex.
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Affiliation(s)
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | | | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | | | | | - Francisco Soldado
- Paediatric Hand Surgery and Microsurgery, Hospital Sant Joan De Deu, Universitat De Barcelona, Barcelona, Spain
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Shibata KR, Matsuda S, Safran MR. Arthroscopic Hip Surgery in the Elite Athlete: Comparison of Female and Male Competitive Athletes. Am J Sports Med 2017; 45:1730-1739. [PMID: 28346833 DOI: 10.1177/0363546517697296] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have published the results of hip arthroscopic surgery in elite athletes and none studying a significant number of elite female athletes. PURPOSE (1) To compare sex-based differences in the ability to return to prior competitive sports activity after arthroscopic hip surgery. (2) To compare sex-based differences in the type of sports activity, diagnosis, and treatment in athletes requiring hip arthroscopic surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data on all elite athletes who underwent primary hip arthroscopic surgery between 2007 and 2014 were included. Athletes with a Hip Sports Activity Scale (HSAS) score of over 6 were identified. The preoperative evaluation included a medical history, history of sports activity, and hip-specific outcome scores (Modified Harris Hip Score [MHHS] and International Hip Outcome Tool-33 [iHOT-33]). Surgical findings and time to return to competitive sports were documented. RESULTS Of 547 hips in 484 consecutive patients, 98 elite athletes (49 female) with a mean follow-up of 18.9 ± 12.8 months were identified. Eighty patients desired to return to their original competitive activity: 38 were female (42 hips; mean age, 21.5 ± 3.9 years), and 42 were male (54 hips; mean age, 20.5 ± 1.9 years). Moreover, 84.2% of female athletes and 83.3% of male athletes were able to return to the same level of competition at a mean of 8.3 ± 3.0 and 8.8 ± 2.9 months, respectively. Significant improvements between preoperative and postoperative outcome scores were seen in both groups (all P < .0001). Female athletes had more pincer femoroacetabular impingement (FAI) ( P = .0004) and instability ( P < .0001). Conversely, male athletes were diagnosed more commonly with combined FAI ( P < .0001), demonstrated greater acetabular cartilage damage ( P = .0004), and required microfracture more often ( P = .0014). Female athletes competed more frequently in flexibility (4/38, 11%; P = .047) and endurance (9/38, 24%) sports, while male athletes participated in cutting (14/42, 33%), contact (6/42, 14%), and asymmetric (13/42, 31%) sports more often. Patients who returned to their baseline level of competition had a shorter duration of symptoms preoperatively ( P = .001). Microfracture status did not affect the ability to return to sports. CONCLUSION Female and male elite athletes were able to return to competitive sports activity at the same or higher level after hip arthroscopic surgery at a similar rate, although their performance in sports was not measured. Distinct differences in the diagnosis, treatment, and type of sports activity between sexes were seen. The duration of symptoms negatively correlated with outcomes. Microfracture did not affect the return to sports.
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Affiliation(s)
- Kotaro R Shibata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA.,Department of Orthopaedic Surgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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31
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Casartelli NC, Brunner R, Maffiuletti NA, Bizzini M, Leunig M, Pfirrmann CW, Sutter R. The FADIR test accuracy for screening cam and pincer morphology in youth ice hockey players. J Sci Med Sport 2017; 21:134-138. [PMID: 28669665 DOI: 10.1016/j.jsams.2017.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Aim of this study was to evaluate the flexion-adduction-internal rotation (FADIR) test accuracy for screening cam and pincer morphology in youth male ice hockey players without diagnosed hip disorders. DESIGN Cross-sectional study. METHODS Seventy-four ice hockey players with a mean age of 16 years (range: 13-20 years) were assessed unilaterally. The presence of cam and pincer morphology was evaluated using the FADIR test and magnetic resonance imaging (MRI) (reference standard). Positive FADIR test consisted of groin pain during the maneuver, while positive MRI findings consisted of (1) pure cam, pure pincer or combined morphology and acetabular labral alterations, or (2) pure cam or combined morphology and acetabular labral alterations. Sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. RESULTS For pure cam, pure pincer or combined morphology as positive MRI findings, the FADIR test demonstrated a sensitivity of 41%, specificity of 47%, positive likelihood ratio of 0.78, negative likelihood ratio of 1.24, positive predictive value of 19% and negative predictive value of 73%. For pure cam or combined morphology as positive MRI findings, the FADIR test showed a sensitivity of 60%, specificity of 52%, positive likelihood ratio of 1.24, negative likelihood ratio of 0.78, positive predictive value of 16% and negative predictive value of 89%. CONCLUSIONS The FADIR test is inadequate for screening cam and pincer morphology in youth ice hockey players without diagnosed hip disorders because of the large number of false positive test outcomes.
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Affiliation(s)
- Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Switzerland; Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
| | | | | | - Mario Bizzini
- Human Performance Lab, Schulthess Clinic, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Switzerland
| | - Christian W Pfirrmann
- Department of Radiology, Orthopaedic University Hospital Balgrist, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopaedic University Hospital Balgrist, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
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Abstract
BACKGROUND There is a dearth of literature examining the causes of cam-type femoroacetabular impingement (FAI) and when such morphology appears. The purpose of the current study was to analyze how the ossific portion of the proximal femur develops over time with respect to standard cam-type FAI parameters. METHODS A collection of 193 femurs from cadavers aged 4 to 21 years were evaluated. The age, sex, ethnicity, and status of the proximal femoral physes (open or closed) of each were recorded. Each specimen was digitally photographed in standardized anteroposterior and modified axial positions. From these photographs, the anterior offset, anterior offset ratio (AOR), and α-angle were determined. A cam lesion was defined as an α-angle >55 degrees on the lateral view. RESULTS The mean age of the specimens was 17.5±4.2 years. The majority were male (69%) and African American (79%) with closed physes (78%). There were significant differences among discrete age groups with respect to α-angle (P=0.01), anterior offset (P<0.01), and AOR (P<0.01). In addition, younger femurs with open physes had a significantly higher mean α-angle (P<0.01), lower mean anterior offset (P<0.01), and higher mean AOR (P<0.01) compared with older ones with closed physes. Specimens defined as having a cam deformity had a statistically higher α-angle (P<0.01) and lower anterior offset (P<0.01), but there was no difference in AOR values compared with specimens without a cam lesion (P=0.1). CONCLUSIONS The apparent decline in α-angles as age increases indicates that the traditional α-angle in younger patients measures a different anatomic parameter (ossified femur excluding the cartilaginous portion) than in older patients (completely ossified femur). This suggests that the bony α-angle is inappropriate in the evaluation of cam lesions in the immature physis. The AOR, rather than the anterior offset, may be more accurate in the evaluation of the growing proximal femur. CLINICAL RELEVANCE This study provides novel insight into, and enhances the understanding of, the development of cam-type FAI.
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Abstract
BACKGROUND Femoroacetabular impingement (FAI) can lead to acetabular chondrolabral damage and has been theorized as a causative factor in the development of osteoarthritis. The pathogenesis of FAI is unknown. The purpose of this study was to determine the prevalence of FAI morphology in asymptomatic adolescents. METHODS We identified children 10 to 18 years of age who had undergone a pelvic CT between 2007 and 2012. Exclusion criteria included hip pain, any hip pathology, bone tumor, long-term steroid use, history of chemotherapy or radiation therapy, nonambulatory status, neuromuscular disorder, chromosomal abnormality, and metabolic bone disease. Multiplanar reformatted images were created from axial images to calculate α angles and lateral center-edge angles (LCEA). Cam morphology was defined as an α-angle ≥55 degrees and pincer morphology as a LCEA≥40 degrees. RESULTS We analyzed 558 patients (1116 hips). There were 276 males and 282 females. The average age was 14.4 years (range, 10.0 to 18.2 y). The mean α-angle was 47.9 degrees (range, 25.7 to 78 degrees) and the mean LCEA was 34.4 degrees (range, 3.9 to 58.6 degrees). Males had a significantly higher mean α-angle (49.7 vs. 46.0 degrees) (P<0.0005) and females had a significantly higher mean LCEA (35.7 vs. 33.0 degrees) (P<0.0005). Ninety-four adolescents (16.8%) had an α-angle ≥55 degrees. Cam morphology was significantly more common in males (23.9% vs. 9.9%) (P<0.001). A total of 181 adolescents (32.4%) had a LCEA≥40 degrees. Pincer morphology was equally common in males and females (29.7% vs. 35.1%) (P=0.17). Thirty-four adolescents (6.1%) had mixed morphologies. Mixed morphologies were found in 21 males (7.6%) and 13 females (4.6%) (P=0.19). The prevalence of pincer morphology increased significantly with increased age in males (P<0.001). CONCLUSIONS The prevalence of cam-type FAI morphology in asymptomatic adolescents is similar to the reported prevalence in asymptomatic adults. Pincer morphology may be more common than cam morphology in adolescents. Cam morphology is more prevalent in males, whereas pincer and mixed morphologies are equally prevalent in both sexes. LEVEL OF EVIDENCE Level III-diagnostic.
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Tresch F, Dietrich TJ, Pfirrmann CW, Sutter R. Hip MRI: Prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement. J Magn Reson Imaging 2016; 46:440-451. [DOI: 10.1002/jmri.25565] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Florian Tresch
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Tobias J. Dietrich
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Christian W.A. Pfirrmann
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Reto Sutter
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
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Dickenson E, Wall PDH, Robinson B, Fernandez M, Parsons H, Buchbinder R, Griffin DR. Prevalence of cam hip shape morphology: a systematic review. Osteoarthritis Cartilage 2016; 24:949-61. [PMID: 26778530 DOI: 10.1016/j.joca.2015.12.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain. DESIGN All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous. RESULTS Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain. CONCLUSIONS There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain.
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Affiliation(s)
| | - P D H Wall
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - B Robinson
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - M Fernandez
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - H Parsons
- Warwick Medical School, United Kingdom.
| | - R Buchbinder
- Monash University Department of Clinical Epidemiology, Australia.
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Abstract
The relationship between hip deformities and osteoarthritis has recently received a lot of attention. In particular, it has been shown that both osteoarthritis and its precursors, such as the hip deformities that lead to femoroacetabular impingement (FAI), are more prevalent in elite athletes compared with the general population. However, the etiology of the above-mentioned types of hip deformity is not currently well understood. Many recent studies have attempted to shed light on the etiology of this disease. In this article, the main clinical, radiological, mechanobiological, and biomechanical findings of relevance to understanding the etiology of hip deformities leading to FAI are reviewed. Based on these findings, a consistent biomechanical theory explaining the development of hip deformities in athletes is then presented. According to the presented theory, the repetitive, impact-like musculoskeletal loads that athletes experience, particularly when they undertake extreme ranges of hip motion, cause the development of hip deformities. According to this theory, these musculoskeletal loads trigger abnormal growth patterns during the years of skeletal development and cause the formation of hip deformities. A number of hypotheses based on the proposed theory are then formulated that could be tested in future studies to ascertain whether the proposed theory could sufficiently describe the development of hip deformities in athletes.
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Affiliation(s)
- Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands,
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37
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Diagnosis and Treatment of Hip Girdle Pain in the Athlete. PM R 2016; 8:S45-60. [DOI: 10.1016/j.pmrj.2015.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/03/2015] [Accepted: 12/18/2015] [Indexed: 01/27/2023]
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de Silva V, Swain M, Broderick C, McKay D. Does high level youth sports participation increase the risk of femoroacetabular impingement? A review of the current literature. Pediatr Rheumatol Online J 2016; 14:16. [PMID: 26968690 PMCID: PMC4788845 DOI: 10.1186/s12969-016-0077-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/07/2016] [Indexed: 11/10/2022] Open
Abstract
Sports participation can be an integral part of adolescent development with numerous positive short and long-term effects. Despite these potential benefits very high levels of physical activity, during skeletal maturation, have been proposed as a possible cause of cam-type femoroacetabular impingement (FAI). The influence of physical activity on the developing physis has been previously described both in animal studies and epidemiological studies of adolescent athletes. It is therefore important to determine whether the development of FAI is secondary to excessive physical activity or a combination of a vulnerable physis and a set level of physical activity. A review of the current literature suggests that adolescent males participating in ice-hockey, basketball and soccer, training at least three times a week, are at greater risk than their non-athletic counterparts of developing the femoral head-neck deformity associated with femoroacetabular impingement.
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Affiliation(s)
- Viran de Silva
- Territory Sports Medicine, Darwin, Northern Territory Australia
| | - Michael Swain
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia ,Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, 2109 Australia
| | - Carolyn Broderick
- Children’s Hospital Institute of Sports Medicine, The Sydney Children’s Hospitals Network, Sydney, Australia ,School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Damien McKay
- Children's Hospital Institute of Sports Medicine, Locked Bag 4001, Westmead, Sydney, New South Wales, 2145, Australia.
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Khan M, Bedi A, Fu F, Karlsson J, Ayeni OR, Bhandari M. New perspectives on femoroacetabular impingement syndrome. Nat Rev Rheumatol 2016; 12:303-10. [PMID: 26963727 DOI: 10.1038/nrrheum.2016.17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoroacetabular impingement (FAI) is characterized by an abnormality in the shape of the femoral head-neck or acetabulum that results in impingement between these two structures. Arthroscopic treatment has become the preferred method of management of FAI owing to its minimally invasive approach. Surgical correction involves resection of impinging osseous structures as well as concurrent management of the associated chondral and labral pathology. Research from the past 5 years has shown that repair of the labrum results in a better anatomic correction and improved outcomes compared with labral debridement. Research is underway to improve cartilage assessment by using innovative imaging techniques and biochemical tests to inform predictions of prognosis. Several ongoing randomized controlled trials, including the Femoroacetabular Impingement Trial (FAIT) and the Femoroacetabular Impingement Randomized Controlled Trial (FIRST), will provide critical information regarding the diagnosis, management and prognosis of patients undergoing arthroscopic management of FAI.
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Affiliation(s)
- Moin Khan
- Division of Orthopaedics, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, Michigan 48105, USA
| | - Freddie Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue 1011, Pittsburgh, Pennsylvania 15213, USA
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, SE 413 45 Gothenburg, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedics, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
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Brunner R, Maffiuletti NA, Casartelli NC, Bizzini M, Sutter R, Pfirrmann CW, Leunig M. Prevalence and Functional Consequences of Femoroacetabular Impingement in Young Male Ice Hockey Players. Am J Sports Med 2016; 44:46-53. [PMID: 26464494 DOI: 10.1177/0363546515607000] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI), which is highly prevalent in adult ice hockey players, is often associated with negative clinical and functional outcomes. It is unclear, however, whether FAI-related bony deformities and symptoms may lead to functional alterations as reflected in hip muscle strength, range of motion (ROM), and on-ice physical performance in youth ice hockey players. HYPOTHESIS Compared with players with neither structural signs nor symptoms related to FAI, players with symptomatic FAI would show hip muscle weakness and reduced hip ROM, which would in turn affect ice hockey physical performance. STUDY DESIGN Controlled laboratory study. METHODS A total of 74 young male ice hockey players were evaluated bilaterally for passive hip internal rotation ROM by use of a hip examination chair. Only the side with less internal rotation ROM was further investigated. FAI-related bony deformities were evaluated with magnetic resonance imaging (MRI). The involved hip was classified as symptomatic or asymptomatic based on the presence of hip pain during exercise and results from the flexion/adduction/internal rotation (FADIR) provocation test. Hip muscle strength, passive hip ROM, and on-ice physical performance were compared between players with no FAI, players with asymptomatic MRI-positive FAI, and players with symptomatic FAI. RESULTS Fifty of 74 players (68%) had FAI-related bony deformities, of whom 16 (22%) were symptomatic. Hip muscle strength, hip ROM, and on-ice physical performance did not differ significantly between players with no FAI and those with asymptomatic or symptomatic FAI. CONCLUSION Despite a high prevalence of FAI-related bony deformities, youth ice hockey players with asymptomatic or symptomatic FAI did not show functional impairments in terms of hip muscle strength, hip ROM, or on-ice physical performance. CLINICAL RELEVANCE Hip muscle strength, passive hip ROM, and on-ice physical performance do not seem to discriminate for FAI-related signs and symptoms in young male ice hockey players.
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Affiliation(s)
- Romana Brunner
- Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | | | | | - Mario Bizzini
- Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Clinic, Zurich, Switzerland
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Levy DM, Hellman MD, Harris JD, Haughom B, Frank RM, Nho SJ. Prevalence of Cam Morphology in Females with Femoroacetabular Impingement. Front Surg 2015; 2:61. [PMID: 26649291 PMCID: PMC4664725 DOI: 10.3389/fsurg.2015.00061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/09/2015] [Indexed: 12/18/2022] Open
Abstract
Cam and pincer are two common morphologies responsible for femoroacetabular impingement (FAI). Previous literature has reported that cam deformity is predominantly a male morphology, while being significantly less common in females. Cam morphology is commonly assessed with the alpha angle, measured on radiographs. The purpose of this study is to determine the prevalence of cam morphology utilizing the alpha angle in female subjects diagnosed with symptomatic FAI. All females presenting to the senior author’s clinic diagnosed with symptomatic FAI between December 2006 and January 2013 were retrospectively reviewed. Alpha (α) angles were measured on anteroposterior and lateral (Dunn 90°, cross-table lateral, and/or frog-leg lateral) plain radiographs by two blinded physicians, and the largest measured angle was used. Using Gosvig et al.’s classification, alpha angle was characterized as (pathologic > 57°), borderline (51–56°), subtle (46–50°), very subtle (43–45°), or normal (≤42°). Three hundred and ninety-one patients (438 hips) were analyzed (age 36.2 ± 12.3 years). Among the hips included, 35.6% were normal, 14.6% pathologic, 15.1% borderline, 14.6% subtle, and 20.1% very subtle. There was no correlation between alpha angle and patient age (R = 0.17) or body mass index (R = 0.05). The intraclass correlation coefficient for α-angle measurements was 0.84. Sixty-four percent of females in this cohort had an alpha angle >42°. Subtle cam deformity plays a significant role in the pathoanatomy of female patients with symptomatic FAI. As the majority of revision hip arthroscopies are performed due to incomplete cam correction, hip arthroscopists need to be cognizant of and potentially surgically address these subtle lesions.
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Affiliation(s)
- David M Levy
- Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - Michael D Hellman
- Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - Joshua D Harris
- Houston Methodist Hip Preservation Center, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital , Houston, TX , USA
| | - Bryan Haughom
- Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - Rachel M Frank
- Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
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Kuhns BD, Weber AE, Levy DM, Wuerz TH. The Natural History of Femoroacetabular Impingement. Front Surg 2015; 2:58. [PMID: 26636088 PMCID: PMC4644807 DOI: 10.3389/fsurg.2015.00058] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/29/2015] [Indexed: 11/13/2022] Open
Abstract
Femoroacetabular impingement (FAI) is a clinical syndrome resulting from abnormal hip joint morphology and is a common cause of hip pain in young adults. FAI has been posited as a precursor to hip osteoarthritis (OA); however, conflicting evidence exists and the true natural history of the disease is unclear. The purpose of this article is to review the current understanding of how FAI damages the hip joint by highlighting its pathomechanics and etiology. We then review the current evidence relating FAI to OA. Lastly, we will discuss the potential of hip preservation surgery to alter the natural history of FAI, reduce the risk of developing OA and the need for future arthroplasty.
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Affiliation(s)
- Benjamin D Kuhns
- Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - Alexander E Weber
- Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - David M Levy
- Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA
| | - Thomas H Wuerz
- Division of Sports Medicine, Center for Hip Preservation, New England Baptist Hospital , Boston, MA , USA
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43
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Nardo L, Parimi N, Liu F, Lee S, Jungmann PM, Nevitt MC, Link TM, Lane NE. Femoroacetabular Impingement: Prevalent and Often Asymptomatic in Older Men: The Osteoporotic Fractures in Men Study. Clin Orthop Relat Res 2015; 473:2578-86. [PMID: 25736918 PMCID: PMC4488192 DOI: 10.1007/s11999-015-4222-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The epidemiology of femoroacetabular impingement (FAI) is important but incompletely understood, because most reports arise from symptomatic populations. Investigating the prevalence of FAI in a community-based cohort could help us better understand its epidemiology and in particular the degree to which it might or might not be associated with hip pain. QUESTIONS/PURPOSES The purposes of this study were (1) to evaluate the proportion of older (≥65 years of age) men with morphologic abnormalities consistent with FAI; and (2) to assess the association of the morphologic abnormalities with prevalent radiographic hip osteoarthritis (OA) and hip pain. METHODS Anteroposterior radiographs were obtained in 4140 subjects (mean age±SD, 77±5 years) from the Osteoporotic Fractures in Men study. We assessed each hip for cam, pincer, and mixed FAI types using validated radiographic definitions. Both intra- and interobserver reproducibility were >0.9. Radiographic hip OA was assessed by an expert reader (intraobserver reproducibility, 0.7-0.8) using validated methods, and summary grades of 2 or greater (on a scale from 0 to 4) were used to define radiographic hip OA. Covariates including hip pain in the last 30 days were collected by questionnaires that were answered by all patients included in this report. Logistic regressions with generalized estimating equations were performed to evaluate the association of radiographic features of FAI and arthrosis. RESULTS Pincer, cam, or mixed types of radiographic FAI had a prevalence of 57% (1748 of 3053), 29% (886 of 3053), and 14% (419 of 3053), respectively, in this group of older men. Both pincer and mixed types of FAI were associated with arthrosis but not with hip pain (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.25-2.13; p<0.001 for pincer and OR, 2.49; 95% CI, 1.65-3.76; p<0.001 for mixed type). Patients with hips characterized by cam-type FAI had slightly reduced hip pain without the presence of arthrosis compared with hips without FAI (OR, 0.82; 95% CI, 0.68-0.99; p=0.037). A center-edge angle>39° and a caput-collum-diaphyseal angle<125° were associated with arthrosis (OR, 1.53; 95% CI, 1.22-1.94; p<0.001 and OR, 2.09; 95% CI, 1.24-3.51; p=0.006, respectively), but not with hip pain (OR, 0.89; 95% CI, 0.77-1.03; p<0.108 and OR, 0.99; 95% CI, 0.67-1.45; p=0.945, respectively). An impingement angle<70° was associated with less hip pain compared with hips with an impingement angle≥70° (OR, 0.76; 95% CI, 0.61-0.95; p=0.015). CONCLUSIONS FAI is common in older men and represents more of an anatomic variant rather than a symptomatic disease. This finding should raise questions on how age, activities, and this anatomic variant each contribute to result in symptomatic disease. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Lorenzo Nardo
- />Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Neeta Parimi
- />California Pacific Medical Research Centre, San Francisco, CA USA
| | - Felix Liu
- />Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Sonia Lee
- />Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Pia M. Jungmann
- />Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Michael C. Nevitt
- />Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Thomas M. Link
- />Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Nancy E. Lane
- />Center for Musculoskeletal Health, University of California at Davis School of Medicine, 4625 2nd Avenue, Suite 1002A, Sacramento, CA 95817 USA , />UC Davis Medical Center, Sacramento, CA USA
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Tannenbaum EP, Zhang P, Maratt JD, Gombera MM, Holcombe SA, Wang SC, Bedi A, Goulet JA. A Computed Tomography Study of Gender Differences in Acetabular Version and Morphology: Implications for Femoroacetabular Impingement. Arthroscopy 2015; 31:1247-54. [PMID: 25979688 DOI: 10.1016/j.arthro.2015.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 01/27/2015] [Accepted: 02/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the prevalence of acetabular retroversion in a large population of patients with asymptomatic hips. Furthermore, we sought to identify gender differences in acetabular morphology to address the current thinking that retroversion and pincer-type femoroacetabular impingement (FAI) are more common in women. METHODS We retrospectively reviewed morphologic features of acetabula from a consecutive series of trauma-protocol computed tomography scans of patients without pelvis injury. An automated algorithm determined the acetabular rim profile and center of the femoral head, normalized the frontal plane of the pelvis, and calculated version and coverage. We then compared male and female rim profiles, specifically focusing on version and acetabular wall coverage in the 1-o'clock (anterosuperior), 2-o'clock (central), and 3-o'clock (inferior) positions. RESULTS Of 1,088 patients in the database, 878 had complete data (i.e., age, ethnicity, and body mass index) and were therefore included in the final analysis. Of these, 34.3% were women and 65.7% were men. Mean global acetabular version was 19.1° for men and 22.2° for women (P < .001). Mean acetabular version for men and women was 15.5° and 18.3°, respectively, in the 1-o'clock position; 21.5° and 24.0°, respectively, in the 2-o'clock position; and 20.2° and 24.3°, respectively, in the 3-o'clock position (P < .001 for all 3). True retroversion (<0°) was observed only in the 1-o'clock position. The prevalence of true acetabular retroversion in the 1-o'clock position for men and women was 4.3% and 3%, respectively (P = .36). CONCLUSIONS Mean global and focal acetabular anteversion was greater in women, and the prevalence of focal cephalad retroversion in the 1-o'clock position was not significantly different compared with men. Acetabular retroversion and anterior overcoverage are not more prevalent in women in the anterosuperior acetabulum, where femoroacetabular impingement most commonly occurs. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Eric P Tannenbaum
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Peng Zhang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Joseph D Maratt
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - M Mustafa Gombera
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Sven A Holcombe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - James A Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
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45
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Radiological variables associated with progression of femoroacetabular impingement of the hip: A systematic review. J Sci Med Sport 2015; 18:122-7. [DOI: 10.1016/j.jsams.2014.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/26/2014] [Accepted: 03/06/2014] [Indexed: 11/17/2022]
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46
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Vo A, Beaule PE, Sampaio ML, Rotaru C, Rakhra KS. The femoral head-neck contour varies as a function of physeal development. Bone Joint Res 2015; 4:17-22. [PMID: 25673625 PMCID: PMC4353131 DOI: 10.1302/2046-3758.42.2000356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate whether the femoral head-neck contour, characterised by the alpha angle, varies with the stage of physeal maturation using MRI evaluation of an asymptomatic paediatric population. METHODS Paediatric volunteers with asymptomatic hips were recruited to undergo MRI of both hips. Femoral head physes were graded from 1 (completely open) to 6 (completely fused). The femoral head-neck contour was evaluated using the alpha angle, measured at the 3:00 (anterior) and 1:30 (anterosuperior) positions and correlated with physeal grade, with gender sub-analysis performed. RESULTS A total of 43 asymptomatic paediatric volunteers (26 male, 17 female) with mean age 13.0 years (eight to 18) were included with review of bilateral hip MRIs. Correlation between the physeal grade and alpha angle was moderate in males at both the 3:00 (r = 0.477, p < 0.001) and 1:30 (r = 0.509, p < 0.001) positions, whereas there was no significant correlation in females. A significant difference was found between the alpha angles of all the physeal grades (3:00, p = 0.030, 1:30, p = 0.005), but only in males, with the angle increasing with higher grades. For physeal grading, the inter-reader reliability was substantial (intraclass correlation coefficient (ICC) = 0.694), and the intra-reader reliability was also substantial (ICC = 0.788). CONCLUSION The femoral head-neck contour varies and correlates with the stage of physeal development, but only in males, with the alpha angle increasing with progressive physeal maturation. This suggests that gender differences exist in the natural physiological growth, development or remodelling of femoral head-neck junction. In males, pre-physeal fusion may be a critical period of vulnerability for development of morphologic abnormalities of the femoral head-neck junction. Cite this article: Bone Joint Res 2015;4:17-22.
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Affiliation(s)
- A Vo
- University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada
| | - P E Beaule
- The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - M L Sampaio
- The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - C Rotaru
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - K S Rakhra
- The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
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47
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Tak I, Weir A, Langhout R, Waarsing JH, Stubbe J, Kerkhoffs G, Agricola R. The relationship between the frequency of football practice during skeletal growth and the presence of a cam deformity in adult elite football players. Br J Sports Med 2015; 49:630-4. [PMID: 25568331 DOI: 10.1136/bjsports-2014-094130] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/03/2022]
Affiliation(s)
- Igor Tak
- Sports Rehabilitation and Manual Therapy Department, Physiotherapy Utrecht Oost, Utrecht, The Netherlands Department of Orthopaedics and Sports Traumatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Adam Weir
- Sports Medicine Department, Sports Groin Pain Centre, Aspetar Hospital, Doha, Qatar
| | - Rob Langhout
- Private Practice Physiotherapy Dukenburg, Nijmegen, The Netherlands
| | - Jan Hendrik Waarsing
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Janine Stubbe
- Amsterdam University of Applied Sciences, School of Sports & Nutrition, Amsterdam, The Netherlands. Codarts University for the Arts, Rotterdam, The Netherlands
| | - Gino Kerkhoffs
- Department of Orthopaedics and Sports Traumatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Roemer FW, Guermazi A. Osteoarthritis year in review 2014: imaging. Osteoarthritis Cartilage 2014; 22:2003-12. [PMID: 25456295 DOI: 10.1016/j.joca.2014.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This narrative review covers original publications related to imaging in osteoarthritis (OA) published in English between April 2013 and March 2014. In vitro data, animal studies and studies with less than 20 observations were not included. METHODS To extract relevant studies, an extensive PubMed database search was performed based on, but not limited to the query terms "Osteoarthritis" in combination with "MRI", "Imaging", "Radiography", "Ultrasound", "Computed Tomography" and "Nuclear Medicine". Publications were sorted according to relevance based on potential impact to the OA research community with the overarching goal of a balanced overview covering all aspects of imaging. Focus was on publications in high impact special interest journals. The literature will be presented in a methodological fashion covering radiography, ultrasound, compositional and morphologic Magnetic resonance imaging (MRI), and from an anatomic perspective including bone, muscle, meniscus and synovitis. RESULTS AND CONCLUSIONS Imaging research in OA in the last year was characterized by a strong focus on MRI-based studies dealing with epidemiological and methodological aspects of the disease. Ultrastructural tissue assessment specifically of cartilage and meniscus using compositional MRI is evolving further. Additional subsets of the large publicly available Osteoarthritis Initiative (OAI) MRI dataset are being analyzed at present and have been published with muscle analyses coming increasingly into the focus of the community. Bone parameters were evaluated using varying technology and a persistent interest in inflammatory disease manifestations has been noted. Other modalities than MRI have been less explored. To date most OA imaging research is still focused on the knee joint.
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Affiliation(s)
- F W Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - A Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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Wall PDH, Brown JS, Parsons N, Buchbinder R, Costa ML, Griffin D. Surgery for treating hip impingement (femoroacetabular impingement). Cochrane Database Syst Rev 2014; 2014:CD010796. [PMID: 25198064 PMCID: PMC11166468 DOI: 10.1002/14651858.cd010796.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Surgery is sometimes recommended for femoroacetabular impingement where non-operative interventions have failed. OBJECTIVES To determine the benefits and safety of surgery for femoroacetabular impingement. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11); MEDLINE (Ovid) (1946 to 19 November 2013); and EMBASE (Ovid) (1980 to 19 November 2013) for studies, unrestricted by language. SELECTION CRITERIA Randomised and quasi-randomised clinical trials assessing surgical intervention compared with placebo treatment, non-operative treatment or no treatment in adults with femoroacetabular impingement. DATA COLLECTION AND ANALYSIS Two authors independently selected trials for inclusion, assessed risk of bias and extracted data. MAIN RESULTS There were no studies that met the inclusion criteria, with 11 studies that were excluded following detailed review. There were four ongoing studies identified that may meet the inclusion criteria when they are completed; the results from these ongoing studies may begin to become available within the next five years. Three of the four ongoing studies are comparing hip arthroscopy versus non-operative care. The fourth study is comparing hip arthroscopy versus a sham arthroscopic hip procedure. All of the ongoing studies are recording at least one of our preferred clinical outcome measures for benefit and safety. AUTHORS' CONCLUSIONS There is no high quality evidence examining the effectiveness of surgery for femoroacetabular impingement. There are four ongoing studies, which may provide evidence for the benefit and safety of this type of surgery in the future.
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Affiliation(s)
- Peter DH Wall
- University of WarwickWarwick Orthopaedics, Warwick Medical SchoolCoventryWarwickshireUKCV4 7AL
- University Hospital Coventry and WarwickshireDepartment of Trauma and OrthopaedicsCoventryUKCV2 2DX
| | - Jamie S Brown
- Helsingborg HospitalDepartment of OrthopaedicsSödra Vallgatan 5HelsingborgSweden251 87
| | - Nick Parsons
- University of WarwickWarwick Orthopaedics, Warwick Medical SchoolCoventryWarwickshireUKCV4 7AL
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Matthew L Costa
- University Hospital Coventry and WarwickshireDepartment of Trauma and OrthopaedicsCoventryUKCV2 2DX
- University of WarwickWarwick Clinical Trials UnitCoventryWarwickshireUKCV4 7AL
| | - Damian Griffin
- University Hospital Coventry and WarwickshireDepartment of Trauma and OrthopaedicsCoventryUKCV2 2DX
- University of WarwickWarwick Clinical Trials UnitCoventryWarwickshireUKCV4 7AL
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Abstract
Context: Several risk factors may cause femoroacetabular impingement (FAI). Knowledge of causation would identify patients for early intervention, prior to the development of painful intra-articular damage. Data Sources: PubMed, MEDLINE, EMBASE, and related article reference lists were screened for relevant studies published between January 2000 and December 2013. Study Selection: Inclusion criteria were (1) etiology of FAI, (2) original FAI clinical data, and (3) English language. Case reports of fewer than 3 patients were excluded. Study Design: Systematic review. Level of Evidence: Level 4. Results: In all, 754 studies were screened, with 18 meeting the eligibility criteria. There were 13 comparative observational studies and 5 case series. The studies pertained to intrinsic patient factors (n = 2), activity/developmental factors (n = 8), hip disease (n = 5), postsurgical changes (n = 2), and malunion after hip fracture (n = 1). Conclusion: A combination of intrinsic patient and developmental factors, activities involving repetitive hip motion, pediatric hip disease, and hip-related surgical procedures may contribute to the development of FAI.
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Affiliation(s)
- Harman Chaudhry
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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