Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting

Plasma metabolomics signatures of developmental dysplasia of the hip in Tibet plateau

BACKGROUND

Developmental dysplasia of the hip (DDH) is a common childhood health complaint, whose etiology is multifactorial. The incidence of DDH is variable and higher in Tibet plateau. Here, we collected plasma samples and studied the metabolomics signatures of DDH.

METHODS

Fifty babies were enrolled: 25 with DDH and 25 age-matched non-DDH healthy controls (HC group). We collected plasma samples, laboratory parameters and conducted untargeted metabolomics profiling.

RESULTS

There are many differential metabolites among patients with DDH, including 4-β-hydroxymethyl-4-α-methyl-5-α-cholest-7-en-3-beta-ol, β-cryptoxanthin, α-tocopherol, taurocholic acid, glycocholic acid, 2-(3,4-dihydroxybenzoyloxy)-4,6-dihydroxybenzoate, arabinosylhypoxanthine, leucyl-hydroxyproline, hypoxanthine. The main differential metabolic pathways focused on primary bile acid biosynthesis, arginine and proline metabolism, phenylalanine metabolism, histidine metabolism, purine metabolism.

CONCLUSIONS

To our knowledge, this is the first report of metabolomics profile in babies with DHH. By combining the α-tocopherol and taurocholic acid, we could achieve the differential diagnosis of DDH.

Is Cam Pincer Deformity a Predisposing Factor for Patellofemoral Pain Syndrome?

Purpose

This study aimed to investigate whether cam and pincer deformities (CPDs) are a risk factor for patellofemoral pain syndrome (PFPS) in women. In addition, it sought to compare the hip joint range of motion and the hip muscle strength of extremities with and without CPDs and PFPS.

Materials and Methods

A total of 82 hips of 41 women with PFPS were included in the study. The mean age of participants was 32.07 ± 7.13 years. The presence of CPDs was detected on digital anterior pelvis radiographs. Pain was evaluated using the visual analog scale, and function using the Kujala scoring system. Maximum isometric muscle strength around the hips was measured using a hand-held dynamometer. Hip joint range of movement angles were measured in all three planes using a universal goniometer.

Results

CPDs were found to predict PFPS in women (p = 0.011, p = 0.048). The rate of CPDs was significantly higher in extremities with PFPS compared to those without PFPS (p = 0.007). The Kujala scores of extremities with cam deformity were significantly lower than those of extremities without pincer deformity (p = 0.043). The internal/external muscle strength ratio was greater, and the abduction/adduction muscle strength ratio was lower in extremities with cam and PFPS than in those without (p = 0.040, p = 0.049). The external rotation and abduction range of movement angles were significantly smaller in extremities with pincer and PFPS compared to those without (p = 0.043, p = 0.035).

Conclusion

CPDs may be a structural predisposing factor in the development of PFPS in women. CPDs assessment when evaluating predisposing factors for PFPS may present an opportunity for the management of PFPS.

Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique

Gluteal tendon tears represent a common but underreported cause of lateral hip pain and dysfunction. In case of conservative management failure, a surgical procedure must be performed to relieve patient symptoms. Current operative treatments, either open or endoscopic, have been however associated with different drawbacks which led to the introduction of the mini-open technique. The aim of this study was to evaluate and report the short-term outcomes of patients operated through the aforementioned surgical technique for gluteus medius (GM) chronic tears. We retrospectively analysed the records of 14 consecutive patients operated at the La Tour hospital by mini-open repair using a double-row technique for full-thickness GM chronic tears. Intra- and post-operative complications were recorded. The pre- and post-operative pain on visual analogue scale (pVAS), modified Harris Hip score (mHHS), abduction strength and gait dysfunction were assessed for all patients. Pre- and post-operative values were compared to evaluate whether improvements were statistically significant and clinically relevant. The study cohort comprised 13 women (93%) and 1 man (3%) aged 62.4 ± 18.0 at index surgery. No intra- or post-operative complications were noted. Compared to pre-operative values, patients reported a significant improvement in mHHS (59.1 ± 7.1 vs 92.7 ± 4.6) and pVAS (7.4 ± 1.0 vs 1.3 ± 1.3) at last follow-up. Patients exhibited a perfect improvement in muscle strength (3.6 ± 0.5 vs 5.0 ± 0.0), and the proportion of patients with a positive Trendelenburg sign decreased from 71% to 0%. Mini-open repair of chronic GM tendon tears using a double-row technique demonstrated excellent clinical and functional outcomes at short follow-up.

Level of Evidence: IV.

Mid- to long-term clinical outcomes of arthroscopic surgery for external snapping hip syndrome

This study evaluated the outcomes of arthroscopic surgery for the treatment of external snapping hip at 2- to 10-year follow-ups. Eighteen patients with refractory external snapping hip treated by arthroscopic surgery were enrolled in this prospective study. All patients underwent unsuccessful conservative treatment for more than 3 months before surgery. We made diamond-shaped defects on the iliotibial band and resected peripheral fibrosis tissues for iliotibial band release with an arthroscopic approach. The visual analog scale (VAS), modified Harris hip score and return to previous level of activity were evaluated as functional outcomes. In addition, residual discomfort or the presentation of complications was also investigated. The average follow up period was 7 years. The modified Harris hip score increased from 70.08 preoperatively to 93.14 postoperatively, and the VAS score decreased from 3.67 preoperatively to 1.17 2 weeks after the operation and declined to 0.33 at the last follow-up. Neither recurrence of snaps nor complications were recorded. Two patients complained of a tight sensation with tenderness after exertion. Our clinical outcomes were compatible with those of previous studies, and no long-term complications were noted, even with a relatively longer follow-up period than what was reported in previous studies. Arthroscopic surgery is a safe and effective treatment that can provide promising long-term clinical outcomes for patients with refractory external snapping hip.

Achievement of the minimal clinically important difference following open proximal hamstring repair

There is a paucity of literature on patient-reported outcome measures (PROMs) following proximal hamstring repair beyond return to play, patient satisfaction and pain improvement. The minimal clinically important difference (MCID) defines the minimum degree of quantifiable improvement that a patient can perceive, but the MCID and predictors of this measure have not been defined for this patient population. This study aimed to define the MCID and determine the efficacy of open proximal hamstring repair through achievement of MCID and identify characteristics predictive of achieving MCID. A retrospective cohort review of an institutional hip registry was conducted, analyzing the modified Harris Hip Score (mHHS) and International Hip Outcome Tool (iHOT-33). MCID was calculated using a distribution-based method. Demographic and clinical variables predictive of achieving MCID were analyzed using univariable and multivariate logistic regression analyses. Thirty-nine patients who underwent open proximal hamstring repair were included. The mean patient age was 48.5 ± 12.4 years, with a mean follow-up of 37.1 ± 28 months. The MCID was determined for each PROM (mHHS—11.8; iHOT-33—12.6). A high percentage of patients achieved MCID for both PROMs (mHHS—85.7%; iHOT-33—91.4%). Univariate logistical regression demonstrated increased age (P = 0.163), increased body mass index (BMI; P = 0.072), requirement for inpatient admission (P = 0.088) and pre-operative iHOT-33 (P = 0.104) trended towards clinically significant predictors of not achieving MCID. A high percentage of patients achieved MCID while age, BMI, inpatient admission and pre-operative iHOT-33 appear to influence the achievement of clinically significant outcome in patients undergoing open proximal hamstring repair.