1
|
Kuhn AW, Clohisy JC, Troyer SC, Cheng AL, Hillen TJ, Pascual-Garrido C, Tatman J, Bloom N, Schoenecker PL, Nepple JJ. Team Approach: Hip Preservation Surgery. JBJS Rev 2023; 11:01874474-202310000-00001. [PMID: 37793005 DOI: 10.2106/jbjs.rvw.23.00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The evaluation and treatment of adolescents and young adults with hip pain has seen tremendous growth over the past 20 years. Labral tears are well established as a common cause of hip pain but often occur because of underlying bony abnormalities. Femoroacetabular impingement (FAI) and acetabular dysplasia are now well-established causes of hip osteoarthritis and are increasingly treated in the prearthritic stage in hopes of improving symptoms and prolonging the longevity of the native hip. Beyond FAI and acetabular dysplasia, this patient population can present with a complex and variable group of underlying conditions that need to be taken into account. Expertise in the conservative management of this population, including physical therapy, is valuable to maximize the success. Preoperative, surgical, and postoperative decision-making and care in this population is complex and evolving. A comprehensive, multidisciplinary approach to the care of this patient population has been used for over 20 years by our institution with great success. The purpose of this article is to review the "team-based approach" necessary for successful management of the spectrum of adolescent and young adult hip disorders.
Collapse
Affiliation(s)
- Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | | | - Abby L Cheng
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Travis J Hillen
- Department of Radiological Science, Washington University in St. Louis, St. Louis, Missouri
| | | | - Justin Tatman
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Nancy Bloom
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Perry L Schoenecker
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
2
|
Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine 2023; 90:105465. [PMID: 36150666 DOI: 10.1016/j.jbspin.2022.105465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023]
Abstract
Hip labral tears are found in 22-55% of individuals with hip pain, but labral tears without cysts are usually not responsible for hip pain, which originates mostly from other structures than the torn labrum, like osteochondral, but also tendinous injuries (rectus femoris, gluteus minimus, iliopsoas) or capsulo-ligamentous tears (iliofemoral ligaments, ligament teres). Those lesions are mainly the consequences of underlying unrecognized functional acetabular dysplasia, and/or femoroacetabular impingements. Although the early repair of labral tears in young sportsmen induces a marked and lasting relief, and might delay the onset of osteoarthritis, the microinstability fostered by labral damages seems less important than underlying dysplasias/impingements. This narrative review details recent findings on: (i) the various mechanisms of pain associated with labral tears; (ii) few evidence for hip microinstability induced by isolated labral tears; (iii) how to best detect labral tears, both clinically (including through IROP test) and on imaging (MRI, MRA, computed tomography arthrography, ultrasound). Some authors suggested to use pull-out tests during surgery, but pulling of hips do not seem to increase much diagnostic performances of ultrasounds. Ultrasound-guided intra-articular and peri-articular injections may tell how often hip pain is exclusively induced by peri-capsular injuries secondary to the acetabular dysplasia/femoro-acetabular impingements already responsible for labral tears. Further works could tell whether labral repair, tendinous debridement, plication of capsule, and/or focal denervation, may induce lasting reliefs of pain induced by the chronic contraction of surrounding muscles (rectus femoris, gluteus minimus, psoas), whose deep aponeuroses mix with the superficial fibres of the thick hip capsule.
Collapse
Affiliation(s)
- Jean-Marie Berthelot
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France.
| | - Kevin Brulefert
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | - Paul Arnolfo
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | - Benoît Le Goff
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | | |
Collapse
|
3
|
Wrolstad K, Mischke JJ, Elias AR. Desmoid fibromatosis presenting as lateral hip pain in an outpatient physical therapy clinic: A case report. Physiother Theory Pract 2023; 39:219-226. [PMID: 34823424 DOI: 10.1080/09593985.2021.2008566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CASE DESCRIPTION A 21-year-old healthy female presented with severe left lateral hip pain beginning suddenly two weeks prior. Physical examination revealed zero degrees of left hip external rotation passive range of motion with a firm end feel and pain severity and irritability out of proportion to an expected musculoskeletal presentation. She was referred to her physician with a recommendation for imaging to determine the source of pain and appropriateness of physical therapy. OUTCOME Magnetic resonance imaging revealed a foreign mass in her left gluteus medius muscle which biopsy revealed to be a desmoid fibromatosis. CONCLUSION This case demonstrates a thorough differential diagnostic process leading to medical imaging referral in a patient with a non-musculoskeletal source of pain. Physical therapists must be diligent in their differential diagnostic process to ensure appropriateness of their treatments or the need for referral.
Collapse
Affiliation(s)
- Kelli Wrolstad
- Physical Therapy Department, University of Montana Physical Therapy, 32 Campus Dr, Missoula, MT, USA
| | - John J Mischke
- Physical Therapy Department, University of Montana Physical Therapy, 32 Campus Dr, Missoula, MT, USA
| | - Audrey Rc Elias
- Physical Therapy Department, University of Montana Physical Therapy, 32 Campus Dr, Missoula, MT, USA
| |
Collapse
|
4
|
Diagnostic Accuracy of Clinical Tests and Imaging Exams for Femoroacetabular Impingement: An Umbrella Review of Systematic Reviews. Clin J Sport Med 2022; 32:635-647. [PMID: 34534982 DOI: 10.1097/jsm.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To synthesize available evidence about diagnostic accuracy of clinical tests and imaging examinations for femoroacetabular impingement (FAI) syndrome. DESIGN Umbrella review. SETTING N/A. PARTICIPANTS N/A. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Systematic reviews (SR) indexed in Embase, LIVIVO, PubMed, SCOPUS, the Cochrane Library, and Web of Science were searched in a 2-phase process. SR assessing diagnostic accuracy were considered eligible. RESULTS From 1520 studies, 6 SR were included, which evaluated 24 primary studies related to FAI syndrome. Of these, 5 SR assessed clinical tests, and a substantial heterogeneity was found concerning reference standards adopted across primary studies, which included arthroscopy, clinical examination (associated or not with imaging exams), intra-articular injections, and open surgery. Most clinical tests presented higher values of sensitivity compared with specificity, although evidence was considered limited because the same primary studies were often included across SR. Nonetheless, evidence around the flexion adduction internal rotation (FADIR) test was considered stronger and its use as a screening tool was consistently supported. Only one SR assessed the accuracy of imaging examinations, which adopted open surgery as the sole reference standard. Most imaging exams presented considerably high values of sensitivity, although specificity values were notably lower. CONCLUSIONS No robust recommendations can be provided for most clinical tests, although the FADIR test, in particular, was consistently supported as a screening tool. Moreover, although imaging examinations showed considerably high sensitivity values, evidence was considered sparse and further research is strongly recommended to validate its use as reference standards for diagnostic accuracy data.
Collapse
|
5
|
Pollock JR, Moore ML, McQuivey KS, Makovicka JL, Economopoulos K, Bingham JS. Clinical Examination of the Hip. N Engl J Med 2022; 386:e65. [PMID: 35704483 DOI: 10.1056/nejmvcm2000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jordan R Pollock
- From the Mayo Clinic Alix School of Medicine, Scottsdale (J.R.P., M.L.M.), and the Mayo Clinic Department of Orthopedic Surgery, Phoenix (K.S.M., J.L.M., K.E., J.S.B.)
| | - M Lane Moore
- From the Mayo Clinic Alix School of Medicine, Scottsdale (J.R.P., M.L.M.), and the Mayo Clinic Department of Orthopedic Surgery, Phoenix (K.S.M., J.L.M., K.E., J.S.B.)
| | - Kade S McQuivey
- From the Mayo Clinic Alix School of Medicine, Scottsdale (J.R.P., M.L.M.), and the Mayo Clinic Department of Orthopedic Surgery, Phoenix (K.S.M., J.L.M., K.E., J.S.B.)
| | - Justin L Makovicka
- From the Mayo Clinic Alix School of Medicine, Scottsdale (J.R.P., M.L.M.), and the Mayo Clinic Department of Orthopedic Surgery, Phoenix (K.S.M., J.L.M., K.E., J.S.B.)
| | - Kostas Economopoulos
- From the Mayo Clinic Alix School of Medicine, Scottsdale (J.R.P., M.L.M.), and the Mayo Clinic Department of Orthopedic Surgery, Phoenix (K.S.M., J.L.M., K.E., J.S.B.)
| | - Joshua S Bingham
- From the Mayo Clinic Alix School of Medicine, Scottsdale (J.R.P., M.L.M.), and the Mayo Clinic Department of Orthopedic Surgery, Phoenix (K.S.M., J.L.M., K.E., J.S.B.)
| |
Collapse
|
6
|
Migliorini F, Maffulli N. Arthroscopic Management of Femoroacetabular Impingement in Adolescents: A Systematic Review. Am J Sports Med 2021; 49:3708-3715. [PMID: 33740385 DOI: 10.1177/0363546521997138] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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 highly prevalent in adolescent athletes. There has been an increasing trend for arthroscopic surgery for FAI, and the results of several clinical studies on outcome after arthroscopic surgery for FAI are available. PURPOSE To conduct a systematic review to investigate the role of arthroscopic management for FAI in adolescents. STUDY DESIGN Systematic review. METHODS This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In August 2020, PubMed, Scopus, Google Scholar, and EMBASE were accessed. All clinical trials concerning the arthroscopic treatment for adolescents with FAI were identified. Only studies on patients aged less than 18 years at the time of surgery reporting data over a minimum follow-up of 12 months were considered. RESULTS Data from 406 adolescents (470 procedures; mean age at surgery, 15.9 years; mean follow-up, 30.4 months) with FAI were retrieved. At a mean of 28.0 months of follow-up, 94% of the adolescents had already returned to sport. All the scores of interest were improved at the final follow-up: visual analog scale (P = .01), modified Harris Hip Score (P < .0001), Non-Arthritic Hip Score (P = .03), Hip Outcome Score-Activities of Daily Living (P = .01), Hip Outcome Score-Sport-Specific Subscale (P < .0001), and Tegner score (P < .0001). Complications occurred in 1.1% (5/470) of procedures, and revision arthroscopy was performed in 4.7% (22/470) of procedures. CONCLUSION Arthroscopic surgery in adolescents with FAI achieves excellent outcomes and a high rate of return to sport, with rates of complication and revision surgery of 1% and 5%, respectively.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
| |
Collapse
|
7
|
Ishøi L, Nielsen MF, Krommes K, Husted RS, Hölmich P, Pedersen LL, Thorborg K. Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment-a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2021; 55:1301-1310. [PMID: 34531185 DOI: 10.1136/bjsports-2021-104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/03/2022]
Abstract
This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.
Collapse
Affiliation(s)
- Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Mathias Fabricius Nielsen
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Kasper Krommes
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Rasmus Skov Husted
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| |
Collapse
|
8
|
Catelli DS, Bedo BLS, Beaulé PE, Lamontagne M. Pre- and postoperative in silico biomechanics in individuals with cam morphology during stair tasks. Clin Biomech (Bristol, Avon) 2021; 86:105387. [PMID: 34044296 DOI: 10.1016/j.clinbiomech.2021.105387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondroplasty for cam femoroacetabular impingement is a common treatment to improve hip function and prevent joint degeneration. The purpose was to compare in-silico hip biomechanics during stair tasks in pre- and postoperative patients matched with healthy controls. METHODS Ten symptomatic cam femoroacetabular impingement patients performed stair ascent and descent pre- and 2 years postoperatively. Patients were age, and body-mass-index matched to controls. Full-body kinematics and kinetics were computed and, muscle and hip contact forces were estimated using musculoskeletal modeling and static optimization. Stance-phases were time-normalized and compared using statistical non-parametric mapping. FINDINGS Preoperatives showed lower hip abduction than controls during stairs ascent (76-100%, P = .007). Pre- and postoperative showed lower hip external rotation compared to controls on stair ascent (Pre-op vs controls: 71-100%, P = .005; Post-op vs controls: 72-100%, P = .01) and stair descent (Pre-op vs controls: 0-62%, P = .001; Post-op vs controls: 0-60%, P = .001). Postoperatives showed lower iliacus force compared to preoperative (1-3%, P = .012) and control (3-6%, P = .008), and higher gluteus maximus and piriformis forces compared to controls during stair descent. Lower postoperative anterior hip contact force (0-7%, P = .004) during descent, and superior (33-35%, P = .018) during ascent compared to controls were observed. Postoperative contact forces were medialized compared to preoperative (0-2%, P = .011) and controls (1-2%, P = .016). INTERPRETATION Forcing participants to adhere to standardized step length/rise minimized sagittal kinematic differences between conditions and groups. Persistent reduced hip external rotation postoperatively and minor muscle force adaptations led to reduced superior hip contact force during stair ascent and reduced anterior and more medialized contact forces during stair descent.
Collapse
Affiliation(s)
| | - Bruno L S Bedo
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
9
|
Nieszporska O, Truszczyńska-Baszak A. Femoroacetabular Impingement of the Hip Joint – Literature Review. REHABILITACJA MEDYCZNA 2021. [DOI: 10.5604/01.3001.0014.8763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: In patients with painful hip joint, femoroacetabular impingement is a relatively frequently diagnosed condition.
Study aim: The aim of the study was to present the anatomy, biomechanics and pathomechanism of femoroacetabular impingement, surgical diagnostics and treatment, as well as physiotherapeutic procedures, and to provide answers to the following questions: 1. What are the causes of femoroacetabular impingement development and what is its most common form? 2. What are the clinical and imaging diagnosis of femoroacetabular impingement based on? 3. What are the goals of physiotherapeutic treatment in the treatment of patients with postoperative femoroacetabular impingement?
Material and method: Current professional literature was analysed based on a review of Internet databases, including Pubmed and Google Scholar.
Results: From the abovementioned Internet databases, 30 items from the current profession-al literature on the analysed variables were identified.
Conclusions: The reasons for the development of femoroacetabular impingement are com-plex, including developmental disorders of the hip joint or its chronic overload. Its most common form is mixed type. The basic imaging test used is anterior-posterior X-ray, while clinical assessment is based on anterior-posterior impingement test. Physiotherapy should be individually tailored and focused on improving range of motion and muscle strength of the hip joint.
Collapse
Affiliation(s)
- Olga Nieszporska
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Poland
| | | |
Collapse
|
10
|
Migliorini F, Liu Y, Eschweiler J, Baroncini A, Tingart M, Maffulli N. Increased range of motion but otherwise similar clinical outcome of arthroscopy over open osteoplasty for femoroacetabular impingement at midterm follow-up: A systematic review. Surgeon 2021; 20:194-208. [PMID: 33731304 DOI: 10.1016/j.surge.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND A systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up. MATERIAL AND METHODS This systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting >12 months follow-up were included. RESULTS Data from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P < 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P < 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P < 0.0001). CONCLUSION Based on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| |
Collapse
|
11
|
Caliesch R, Sattelmayer M, Reichenbach S, Zwahlen M, Hilfiker R. Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review. BMJ Open Sport Exerc Med 2020; 6:e000772. [PMID: 32411383 PMCID: PMC7213881 DOI: 10.1136/bmjsem-2020-000772] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 01/31/2023] Open
Abstract
Objectives To determine the diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected femoroacetabular impingement (FAI) syndrome and to evaluate their clinical utility. Design A systematic review of studies investigating the diagnostic accuracy of clinical tests for cam and pincer morphology. Data sources PubMed, Embase, CINAHL and SPORTDiscus. Eligibility criteria for selecting studies Studies investigating the diagnostic accuracy of clinical tests for cam, pincer or mixed morphology in symptomatic patients. Patients had to undergo an index test and a reference test able to identify cam or pincer morphology. Study results have to allow the calculation of true or false positives and/or negatives to calculate sensitivity, specificity, likelihood ratios (LR) and post-test probabilities. Results Eight studies were included, investigating 17 tests and two test combinations. The studies reported a low specificity for all tests, ranging from 0.11 to 0.56. Sensitivity ranged from 0.11 to 1.00, with high sensitivities for the flexion-adduction-internal rotation (FADIR), foot progression angle walking (FPAW) and maximal squat tests. We estimated that negative test results on all of these three tests would result in a negative LR of 0.15. However, we judged the studies to provide low-quality evidence. Conclusion There is low-quality evidence that negative test results reduce the post-test probability of cam or mixed morphologies and that consecutive testing with the FADIR, FPAW and maximal squat tests might be used as a clinical test combination. We would not recommend their use to confirm the diagnosis of FAI syndrome. PROSPERO registration number CRD42018079116.
Collapse
Affiliation(s)
- Rahel Caliesch
- Physiotherapy, HES-SO Valais-Wallis, Leukerbad, Valais-Wallis, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Martin Sattelmayer
- Physiotherapy, HES-SO Valais-Wallis, Leukerbad, Valais-Wallis, Switzerland
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Rheumatology, Immunology, and Allergology, Bern University Hospital, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Roger Hilfiker
- Physiotherapy, HES-SO Valais-Wallis, Leukerbad, Valais-Wallis, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| |
Collapse
|
12
|
Cvetanovich GL, Beck EC, Chalmers PN, Espinoza Orías AA, Stover MD, Inoue N, Nho SJ. Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography. Arthrosc Sports Med Rehabil 2020; 2:e113-e120. [PMID: 32368747 PMCID: PMC7190544 DOI: 10.1016/j.asmr.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/12/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To determine the 3-dimensional (3D) in vivo hip translation in patients with symptomatic femoroacetabular impingement syndrome (FAIS) using 3D computed tomography (CT) models with the hip in neutral and FABER (flexion, abduction, and the external rotation) positions and to identify patient predictors associated with the degree of hip translation. Methods Seventy-eight patients with FAIS and cam lesions underwent CT scans in neutral and FABER positions. Demographics including age, sex, and body mass index (BMI) were recorded for each patient. The cam deformity was characterized both in plain x-ray film and 3D. Translation between both positions was calculated using a validated high-precision 3D-3D registration technique. Univariate and multivariate regression analyses sought factors correlated with translation. Results The mean age of the patients included in the analysis was 36.3 ± 9.2 years, with 51% of the study group being female. The mean 3D femoral head center translation was 0.84 ± 0.37 mm, decomposed into vectors on standard anatomical directions as 0.13 ± 0.58 mm medial, 0.10 ± 0.54 mm posterior, and 0.08 ± 0.46 mm inferior. Multivariate analysis demonstrated that total translation was associated with larger alpha angles (β = 0.014; 95% confidence interval [CI] 0.003-0.024; P = .013), and greater BMI (β = 0.033; 95% CI 0.001-0.065; P = .042). Furthermore, posterior–inferior translation was associated with BMI (β = 0.032; 95% CI 0.003-0.061; P = .031), whereas medial–lateral translation is associated with the female sex (β = 0.388; 95% CI 0.124-0.634; P = .002), and smaller head radius (β = –0.068; 95% CI –0.128 to –0.007; P = .029). Conclusions As a provocative maneuver, FABER positioning in patients with FAIS resulted in an average measurable translation of the femoral head center in the posterior, medial, and inferior direction. Factors including sex, BMI, and alpha angle predicted the degree of translation. Clinical Relevance The current study demonstrates that there is measurable hip translation between the neutral and FABER positions in patients with symptomatic FAIS, which may cause hip microinstability. Furthermore, the study found an association between hip translation and both modifiable and nonmodifiable factors. This may indicate the need for more comprehensive preoperative surgical planning, intraoperative dynamic examination of the hip, and consideration of capsular plication in certain patients.
Collapse
Affiliation(s)
- Gregory L Cvetanovich
- Department of Orthopedic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Peter N Chalmers
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Michael D Stover
- Department of Orthopedic Surgery, Northwestern University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
13
|
Salas C, Sintes P, Joan J, Urbano D, Sospedra J, Caparros T. Conservative management of femoroacetabular impingement (FAI) in professional basketball. APUNTS SPORTS MEDICINE 2020. [DOI: 10.1016/j.apunsm.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
14
|
Mosler AB, Kemp J, King M, Lawrenson PR, Semciw A, Freke M, Jones DM, Casartelli NC, Wörner T, Ishøi L, Ageberg E, Diamond LE, Hunt MA, Di Stasi S, Reiman MP, Drew M, Friedman D, Thorborg K, Leunig M, Bizzini M, Khan KM, Crossley KM, Agricola R, Bloom N, Dijkstra HP, Griffin D, Gojanovic B, Harris-Hayes M, Heerey JJ, Hölmich P, Impellizzeri FM, Kassarjian A, Warholm KM, Mayes S, Moksnes H, Risberg MA, Scholes MJ, Serner A, van Klij P, Lewis CL. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. Br J Sports Med 2019; 54:702-710. [DOI: 10.1136/bjsports-2019-101457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 01/12/2023]
Abstract
Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.
Collapse
|
15
|
Andronic O, Nakano N, Daivajna S, Board TN, Khanduja V. non-arthroplasty iliopsoas impingement in athletes: a narrative literature review. Hip Int 2019; 29:460-467. [PMID: 30942093 DOI: 10.1177/1120700019831945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Iliopsoas impingement occurs secondary to a tight iliopsoas tendon that causes impingement during movement. This review presents current aspects regarding the diagnosis of iliopsoas impingement and also exposes the readers to the possible anatomic and clinical variations together with the available treatment options. METHODS We conducted a narrative literature review with regard to non-arthroplasty iliopsoas impingement. RESULTS Iliopsoas impingement is characterised by a distinct pattern of labral pathology, with anteriorly localised labral damage, that does not extend to the anterosuperior portion of the acetabulum. Anterior groin pain and intermittent catching, snapping or popping of the hip are common symptoms. Non-specific focal tenderness is often found over the iliopsoas tendon at the level of the anterior aspect of the joint. The 'C-sign' and Impingment test are usually positive. Dynamic ultrasonography is also useful for confirming the diagnosis. Initial management of painful iliopsoas impingement should be conservative. When patients continue to have pain, an ultrasound-guided injection can provide relief and predict the response to the surgical release. For patients who have recurrent pain after local injection of steroids, arthroscopic release has shown to achieve effective results. CONCLUSIONS Although different treatment options for iliopsoas impingement are emerging, the current standard of therapy is conservative followed by an arthroscopic tenotomy if necessary. Young adult hip surgeons should always keep this differential in mind in a patient presenting with groin pain and mechanical symptoms.
Collapse
Affiliation(s)
- Octavian Andronic
- 1 Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Naoki Nakano
- 2 Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Sachin Daivajna
- 3 Department of Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Tim N Board
- 4 Department of Orthopaedics, Wrightington Hospital, Wigan, UK
| | - Vikas Khanduja
- 2 Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
16
|
Lohr C, Schmidt T, Medina-Porqueres I, Braumann KM, Reer R, Porthun J. Diagnostic accuracy, validity, and reliability of Tensiomyography to assess muscle function and exercise-induced fatigue in healthy participants. A systematic review with meta-analysis. J Electromyogr Kinesiol 2019; 47:65-87. [DOI: 10.1016/j.jelekin.2019.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/16/2019] [Accepted: 05/03/2019] [Indexed: 02/04/2023] Open
|
17
|
Nazal MR, Parsa A, Martin SD. Arthroscopic Diagnosis and Treatment of Chronic Hip Pain After Total Hip Arthroplasty and the Role of Anterior Capsule Disruption in Iliopsoas Tendinopathy. Orthop J Sports Med 2019; 7:2325967119854362. [PMID: 31276006 PMCID: PMC6598328 DOI: 10.1177/2325967119854362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The use of hip arthroscopic surgery in patients suffering from chronic hip pain after total hip arthroplasty (THA) has a limited presence in the literature, with most studies having limited follow-up. Purpose: The first goal of this study was to evaluate hip arthroscopic surgery in the diagnosis and management of patients with chronic hip pain after THA. The second goal was to describe a new cause of iliopsoas tendinopathy (IPT) involving disruption of the anterior capsule. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective analysis with prospectively collected clinical outcomes of patients after THA who underwent hip arthroscopic surgery for chronic hip pain without an identifiable cause. The patients were at least 18 years old and had a minimum follow-up of 24 months. Results: The retrospective analysis found that hip arthroscopic surgery led to new diagnostic information in 8 patients (80%). Of the 10 patients diagnosed with IPT, 4 (40%) lacked an anatomic cause; however, these patients had a history of difficult exposure of the anterior capsule and/or a lack of capsular repair during index THA. The mean modified Harris Hip Score (mHHS) was 71.9 ± 15.6, and the mean 6-month postoperative visual analog scale (VAS) pain score was 0.8 ± 2.2, which was significantly lower than preoperatively (P = .0055). There was also significantly improved forward flexion range of motion (P = .0183) and straight leg raise (SLR) strength test results (P = .0263). Hip arthroscopic surgery resulted in 8 patients (80%) continuing to be pain-free at a mean follow-up of 6.8 ± 1.4 years, while 2 patients (20%) progressed to revision arthroplasty. There were no major or minor complications. Conclusion: Hip arthroscopic surgery was found to have an important role in the diagnostic and therapeutic management of patients with chronic hip pain after THA, with good clinical outcomes at a mean follow-up of 6.8 years and no complications. We believe that disruption of the anterosuperior acetabular capsule, including the reflected head of the rectus femoris, can allow the iliopsoas tendon to move intra-articularly and precipitate IPT. This disruption may be appreciated on the SLR strength test. Although this study presents a small sample size that cannot substantiate a cause-effect relationship, orthopaedic surgeons performing THA should consider minimizing disruption and/or ensuring repair of the anterior capsule to decrease this potential cause of IPT.
Collapse
Affiliation(s)
- Mark R Nazal
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ali Parsa
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Scott D Martin
- Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Abstract
Femoroacetabular impingement (FAI) is a common cause of hip pain that can affect a wide range of patients. It is due to altered bony morphology of the proximal femur and acetabulum, resulting in decreased function and progression to early osteoarthritis. Until the early 2000s, little was known or understood about the significance of FAI as a clinical entity. The field of hip preservation has grown exponentially since that time, and has led to many advances in caring for those with symptomatic impingement. This review details the early diagnosis and proper management of femoroacetabular impingement for the sports medicine practitioner.
Collapse
Affiliation(s)
- Travis J Menge
- a Department of Orthopedic Surgery , University of South Dakota Sanford School of Medicine - Orthopedic Surgery , Vermillion , SD , USA
| | - Nathan W Truex
- b Regional Health Medical Center - Orthopedic Surgery , Rapid City , SD , USA
| |
Collapse
|
19
|
Frangiamore S, Mannava S, Geeslin AG, Chahla J, Cinque ME, Philippon MJ. Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 1, Physical Examination. Arthrosc Tech 2017; 6:e1993-e2001. [PMID: 29399467 PMCID: PMC5792748 DOI: 10.1016/j.eats.2017.03.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
A thorough evaluation of the hip must include a comprehensive medical and surgical history focused on the hip joint, surrounding soft tissues, and the associated structures of the spine, pelvis, and lower extremities. These details can guide the physical examination and provide insight into the cause of the patient's chief complaints. A proper examination includes physical examination while the patient is in the upright, supine, prone, and lateral position, as well as an evaluation of gait. Guided by a thorough history, the physical examination enables the surgeon to distinguish between intra-articular and extra-articular contributors to hip pain, selection of appropriate imaging modalities, and ultimately supports medical decision making.
Collapse
Affiliation(s)
| | - Sandeep Mannava
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Mark E. Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marc J. Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Marc J. Philippon, M.D., Steadman Philippon Research Institute, The Stedman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, U.S.A.Steadman Philippon Research InstituteThe Stedman Clinic181 West Meadow DriveSuite 400VailCO81657U.S.A.
| |
Collapse
|
20
|
Prather H, Creighton A, Sorenson C, Simpson S, Reese M, Hunt D, Rho M. Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia. PM R 2017; 10:455-461. [PMID: 29111466 DOI: 10.1016/j.pmrj.2017.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/09/2017] [Accepted: 10/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND In young and middle-aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety. OBJECTIVE The objective of this study was to compare assessments of insomnia and anxiety in young and middle-aged adults presenting with hip pain with no greater than minimal osteoarthritis (OA) compared to asymptomatic healthy controls. Comparisons between types of hip deformity and no hip deformity in hip pain patients were performed to assess whether patients with specific hip deformities were likely to have insomnia or anxiety as a cofounding disorder to their hip pain. DESIGN Prospective case series with control comparison. SETTING Two tertiary university physiatry outpatient clinics. PARTICIPANTS A total of 50 hip pain patients aged 18-40 years and 50 gender- and age-matched healthy controls. METHODS Patients were enrolled if 2 provocative hip tests were found on physical examination and hip radiographs had no or minimal OA. Radiographic hip deformity measurements were completed by an independent examiner. Comparisons of insomnia and anxiety were completed between 50 hip pain patients and 50 controls and between patients with different types of hip deformity. MAIN OUTCOME MEASURES Insomnia Severity Index (ISI) and Pain Anxiety Symptoms Scale (PASS). RESULTS A total of 50 hip pain patients (11 male and 39 female) with mean age of 31.2 ± 8.31 years enrolled. Hip pain patients slept significantly less (P = .001) per night than controls. Patients experienced significantly greater insomnia (P = .0001) and anxiety (P = .0001) compared to controls. No differences were found in insomnia and anxiety scores between hip pain patients with and without hip deformity or between different types of hip deformity. CONCLUSION Hip pain patients with radiographs demonstrating minimal to no hip arthritis with and without hip deformity experience significant cofounding yet modifiable disorders of sleep and anxiety. If recognized early in presentation, treatment of insomnia and anxiety ultimately will improve outcomes for hip patients treated either conservatively or surgically for their hip disorder. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Heidi Prather
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Creighton
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chris Sorenson
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Scott Simpson
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maria Reese
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Devyani Hunt
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Monica Rho
- Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St Louis, MO 63110.,Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St Louis, MO.,Program in Physical Therapy, Washington University School of Medicine, St Louis, MO.,Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St Louis, MO.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
21
|
Haldane CE, Ekhtiari S, de Sa D, Simunovic N, Ayeni OR. Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy-a systematic review. J Hip Preserv Surg 2017; 4:201-213. [PMID: 28948032 PMCID: PMC5604278 DOI: 10.1093/jhps/hnx020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/01/2017] [Accepted: 04/26/2017] [Indexed: 11/12/2022] Open
Abstract
The purpose of this systematic review is to report current preoperative assessment for femoroacetabular impingement (FAI) including physical examination and imaging modalities prior to hip arthroscopy, and report current imaging measures used in the diagnosis of FAI. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, non-operative treatment, preoperative assessment including physical examination and imaging prior to hip arthroscopy were abstracted. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. Sixty-eight studies of fair quality evidence that involved a total of 5125 patients (5400 hips) were included. In total, 56% of all patients were male and mean age was 36 years (SD ± 10.0). Within physical examination, FADIR impingement testing was reported in 57% of patients. All included studies reported plain radiographic imaging as a component of preoperative assessment with anterior–posterior pelvis view being the most commonly reported view, followed by the cross-table lateral and Dunn views. Magnetic resonance imaging was obtained for 52% of included patients and computed tomography for 26% of patients. The most commonly reported measure within imaging for the diagnosis of cam type impingement was alpha angle (66%), whereas for pincer type impingement, the cross-over sign (48%) was most reported. Preoperative assessment is underreported in the FAI literature. Improved reporting is warranted to develop a more consistent and validated diagnostic algorithm for FAI to enhance patient selection. Level of evidence: Level IV, Systematic Review of Level I–IV Studies.
Collapse
Affiliation(s)
- Chloe E Haldane
- Michael G. DeGroote School of Medicine, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - Seper Ekhtiari
- Michael G. DeGroote School of Medicine, 1280 Main St. W., Hamilton, ON, L8S 4K1, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St. W., Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, Centre for Evidence-Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St. W., Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| |
Collapse
|