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Le HM, d'Hemecourt PA, Jackson SS, Whitney KE, Miller PE, Millis MB, Wuerz TH, Kiapour AM, Lewis CL, Stracciolini A. Protocol and validity testing of femoroacetabular posterior translation with dynamic hip ultrasonography. Skeletal Radiol 2024; 53:1287-1293. [PMID: 38217703 DOI: 10.1007/s00256-024-04560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To describe femoroacetabular posterior translation (FAPT) using dynamic hip ultrasonography (DHUS), and to determine the inter- and intra-rater reliability of hip ultrasound measurements of FAPT. MATERIALS AND METHODS The study design was a feasibility study of 13 healthy young adults (26 hips) using test-retest analysis. The data was collected prospectively over a 2-week time period. Three DHUS measurements (posterior neutral (PN), flexion, adduction, and internal rotation (PFADIR), and stand and load (PStand) were measured by four independent raters (2 senior who divided the cohort, 1 intermediate, 1 junior) at two time points for bilateral hips of each participant. Reliability was assessed by calculating the intraclass correlation coefficient (ICC) along with 95% confidence intervals (CIs) for each rater and across all raters. RESULTS A total of 468 US scans were completed. The mean age of the cohort was 25.7 years (SD 5.1 years) and 54% were female. The inter-rater reliability was excellent for PFADIR (ICC 0.85 95% CI 0.76-0.91), good for PN (ICC 0.69 95% CI 0.5-0.81), and good for PStand (ICC 0.72 95% CI 0.55-0.83). The intra-rater reliability for all raters was good for PFADIR (ICC 0.60 95% CI 0.44-0.73), fair for PN (ICC 0.42 95% CI 0.21-0.59), and fair for PStand (ICC 0.42 95% CI 0.22-0.59). CONCLUSION This is the first study to present a protocol using dynamic ultrasonography to measure FAPT. DHUS measure for FAPT was shown to be reliable across raters with varying levels of ultrasound experience.
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Affiliation(s)
- Hung M Le
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA.
- Health Services, Brown University, Providence, RI, USA.
| | - Pierre A d'Hemecourt
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah S Jackson
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin E Whitney
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
| | - Michael B Millis
- Harvard Medical School, Boston, MA, USA
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Thomas H Wuerz
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
- Center for Hip Preservation, Division of Sports Medicine, New England Baptist Hospital, Boston, MA, USA
| | - Ata M Kiapour
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Andrea Stracciolini
- Department of Orthopedics, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
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Fujiwara Y, Shoji T, Ota Y, Saka H, Inoue T, Kato Y, Sumii J, Yasunaga Y, Adachi N. Relationships among hip instability, iliofemoral ligament, and pain in patients with developmental dysplasia of the hip. J Orthop Sci 2024; 29:835-840. [PMID: 36931978 DOI: 10.1016/j.jos.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/25/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND To evaluate the relationships among hip instability, pain, and morphology of the iliofemoral ligament (ILFL) in patients with developmental dysplasia of the hip (DDH) using ultrasonography (US). METHODS We reviewed 86 patients (109 hips) with DDH (Group D), 40 patients (46 hips) with borderline hip dysplasia (BDDH) (Group B) and 20 patients (23 hips) without hip pain and bony abnormality (control group). Group D was classified into three subgroups-the severe (group SP), moderate (group MP), and none/mild (group NMP) hip pain groups-using the visual analogue scale (VAS). For evaluating hip instability and ILFL morphology, the distance between the anterior edge of the anterior inferior iliac spine (AIIS) and the horizontal line to the femoral head, and ILFL thickness were measured using US. The difference between the distance in the neutral position and Patrick position was calculated and defined as the femoral head translation distance (FTD). RESULTS FTD and ILFL thickness in group D were significantly larger than those in the control group and group B (P < 0.05). There was a significant positive correlation between FTD and ILFL thickness in three groups (r = 0.57, P < 0.05; r = 0.55, P < 0.05; r = 0.62, P < 0.05, respectively). FTD and ILFL thickness in group SP were significantly larger than those in group NMP (P < 0.05). FTD and ILFL thickness in group D had significantly negative correlations with the lateral center edge (r = -0.54, P < 0.05; r = -0.40, P < 0.05, respectively) and vertical-center-anterior angle (r = -0.51, P < 0.05; r = -0.43, P < 0.05, respectively). CONCLUSIONS Acetabular bony deficiency, especially in the anterior and lateral region can result in antero-posterior hip instability, leading to thickened ILFL and hip pain, even in patients with BDDH. These findings may facilitate our understanding and treatment of patients with DDH. When hip instability is suspected, hip US examination may help confirm the diagnosis and assist in providing objective clinical diagnostic evidence.
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Affiliation(s)
- Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima, 739-0036, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Millis MB. Hipology 2023: Science, Philosophy, and Craft. HSS J 2023; 19:467-472. [PMID: 37937082 PMCID: PMC10626935 DOI: 10.1177/15563316231192095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Michael B Millis
- Child and Adult Hip Program, Boston Children's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
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Zhang AW, Nakonezny PA, Chhabra A, Fey N, Wells J. Dysplastic hips demonstrate increased joint translation at higher body mass index. Skeletal Radiol 2023; 52:715-723. [PMID: 36224400 DOI: 10.1007/s00256-022-04205-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine which radiographic measures used to define the severity of hip dysplasia are associated with hip joint translation and to investigate relationships between position, body mass index, and joint translation. MATERIALS AND METHODS This is a cross-sectional retrospective study evaluating 10 validated radiographic measures of dysplasia on weight-bearing AP pelvis and supine 45-degree bilateral Dunn radiographs of 93 young adults with symptomatic hip dysplasia presenting to a single academic institution between October 2016 and May 2019. We determined the difference between standing and supine measurements for each hip and the correlation of each measure with the patient's body mass index. RESULTS Femoral head extrusion index was 2.49% lower on supine X-ray (p = 0.0020). Patients with higher body mass index had higher center gap distance (p = 0.0274), femoral head extrusion (p = 0.0170), and femoral head lateralization (p = 0.0028) when standing. They also had higher Tönnis angle (pstanding = 0.0076, psupine = 0.0121) and lower lateral center-edge angle (pstanding = 0.0196, psupine = 0.0410) in both positions. The difference in femoral head lateralization between standing and supine positions increased with higher body mass index (p = 0.0081). CONCLUSION Translation of the hip joint with position change is demonstrated by decreased femoral head extrusion index on supine X-ray. Patients with higher body mass index had more dysplastic hips, as measured by five of six radiographic outcomes of dysplasia, and experienced more translation with weight-bearing, reflected by increased femoral head lateralization.
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Affiliation(s)
| | - Paul A Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Orthopedics, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nicholas Fey
- Department of Bioengineering, University of Texas at Dallas, Dallas, TX, 75080, USA
| | - Joel Wells
- Department of Orthopedics, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
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Sahr ME, Endo Y, Sink EL, Miller TT. Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement. Skeletal Radiol 2023; 52:1385-1393. [PMID: 36598522 DOI: 10.1007/s00256-022-04264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE In this technical report, we describe our protocol for the dynamic sonographic evaluation of the hip and assess reliability of the ultrasound assessment of hip microinstability. MATERIALS AND METHODS Our clinical experience with a standardized dynamic ultrasound of the hip performed in a series of 27 patients with imaging performed by an experienced musculoskeletal radiologist during physical examination by an orthopedic surgeon specializing in hip preservation is illustrated with clinical photographs and ultrasound images from volunteers and selected patients. Interrater reliability for the diagnosis of microinstability was calculated. RESULTS Dynamic ultrasound technique and findings of hip instability, femoroacetabular impingement, and ischiofemoral impingement with corresponding clinical photos showing the necessary physical examination maneuvers are described. Interrater agreement for the diagnosis of microinstability was substantial (κ 0.606 [0.221-0.991]). CONCLUSION At our institution, dynamic ultrasound of the hip during physical examination complements information gathered from static imaging by providing real-time correlation of symptoms with what is occurring anatomically.
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Affiliation(s)
- Meghan E Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA.
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| | - Ernest L Sink
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
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Jean PO, Safran MR, Ayeni OR. Hip microinstability: fact or fiction? Knee Surg Sports Traumatol Arthrosc 2023; 31:1-3. [PMID: 35064288 DOI: 10.1007/s00167-021-06835-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/02/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Pierre-Olivier Jean
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St, Pavillion A, Redwood City, CA, 94063, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Mezian K, Ricci V, Güvener O, Jačisko J, Novotný T, Kara M, Chang KV, Naňka O, Pirri C, Stecco C, Dughbaj M, Jain NB, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for (Adult) Hip. Am J Phys Med Rehabil 2022; 101:e162-e168. [PMID: 35687784 DOI: 10.1097/phm.0000000000002061] [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: 11/26/2022]
Abstract
ABSTRACT In this dynamic scanning protocol, ultrasound assessment of the adult hip is described using different maneuvers for various conditions. Real-time patient examination and ultrasound scanning videos are coupled for convenience as well as for better insight. The text covers the common conditions around the hip where especially dynamic ultrasound scanning provides valuable information in addition to static imaging. The protocol is prepared by an international consensus of several experts in the field of musculoskeletal ultrasound.
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Affiliation(s)
- Kamal Mezian
- From the Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic (KM); Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ); Department of Orthopaedics, University J.E. Purkinje, Masaryk Hospital, Usti nad Labem, Czech Republic (TN); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan (K-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K-VC); Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic (ON); Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait (MD); and Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas (NBJ)
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Stracciolini A, Yen YM, Miller PE, Whitney KE, Jones J, Novais EN, d'Hemecourt PA. Generalized Joint Laxity Is Associated With Dynamic Hip Ultrasonography Measures in Female Athlete Patients Who Are Not Hypermobile. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2343-2353. [PMID: 34927276 DOI: 10.1002/jum.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate ultrasound (US) femoroacetabular translation measurements in female athlete patients. METHODS A prospective cross-sectional study was conducted in female athlete patients <50 years. Demographic data, Beighton score/hypermobility status, and sport participation were collected. Hip dysplasia was determined using radiographic measurements (lateral center edge angle, anterior center edge angle, Tönnis angle); femoral version angles were measured with CT or MR. Femoroacetabular translation US measures included neutral (N), neutral flexed (NF), extension external rotation/apprehension (EER) positions. Maximal difference (delta) between US measures was calculated. RESULTS 206/349 female hips were analyzed (median age 21.2 years [range, 12-49.5]). The primary sport group was performing arts (45%, 92/206). Mean Beighton score was 5.2 (SD, 2.5) with 61% (129/206) of hips exhibiting hypermobility (Beighton score ≥5). For each additional unit of Beighton score, N US measurement increased by 0.7 mm (β = 0.7; 95% confidence interval [CI] = 0.22-1.25; P < .001), NF by 1 mm ( β = 0.9; 95% CI = 0.3-1.43; P = .002) and EER by 0.8 mm ( β = 0.8; 95% CI = 0.27-1.37; P < .001) when adjusting for age and dysplasia status. A positive correlation was detected between NF (r = 0.19; 95% CI = 0.05-0.33; P = .007) and EER (r = 0.19; 95% CI = 0.05-0.32; P = .01) with Tönnis angle and a negative correlation between the delta and femoral version (r = -0.20; 95% CI = -0.35 to 0.03; P = .02). No difference in US measures was detected across sport groups (N [P = .24], NF [P = .51], EER [P = .20], delta [P = .07]). CONCLUSION Beighton score was independently associated with dynamic US measures in female athlete patients who are not hypermobile when controlling for other factors.
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Affiliation(s)
- Andrea Stracciolini
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin E Whitney
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jacob Jones
- Scottish Rite for Children, Dallas, TX, USA
- Department of Orthopaedics, University of Texas Southwestern, Dallas, TX, USA
| | - Eduardo N Novais
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pierre A d'Hemecourt
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ruh E, Johnson C, Frankston N, Charles S, Anderst W, McClincy M. Does Femoral Head Translation Vary by Sex and Side in Asymptomatic Hips During a Weightbearing Apprehension Test? Clin Orthop Relat Res 2022; 480:1104-1111. [PMID: 35195575 PMCID: PMC9263503 DOI: 10.1097/corr.0000000000002144] [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: 05/24/2021] [Accepted: 01/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip microinstability is an increasingly recognized source of pain and dysfunction but has no agreed upon diagnostic criteria and the pathophysiology remains unclear. It has been suggested that pain associated with microinstability is caused by excess translation of the femoral head. Recent research indicates that single-plane femoral head translation can be reliably measured using dynamic ultrasonography during a supine clinical examination; however, the overall accuracy of that technique has not been established, and the range of femoral head translation values that are found in individuals with no history of surgery or symptomatic pathology is unknown. QUESTIONS/PURPOSES (1) How much femoral head translation is present in native, uninjured hips during a weightbearing apprehension position for females and males? (2) How large is the side-to-side difference in hip translation and rotation within the same individual in females and males with no history of surgery or pain during the weightbearing apprehension position? (3) What differences exist in femoral head translation and rotation when comparing females to males? METHODS Twenty-two young adults (11 males, 11 females; mean age 22 ± 2 years; BMI 22 ± 5 kg/m2) with no history of hip pain, no known hip injury, and who never had hip surgery participated in this study. High-resolution CT images of the femur and pelvis were acquired for each participant, and the bone tissue was segmented from the CT volume. Synchronized biplane radiographs were collected during a neutral standing trial and during a static weightbearing apprehension position in which the participant extended, externally rotated, and abducted at their back hip while standing with their feet split in the AP direction. A validated volumetric model-based tracking technique was used to match the patient-specific bone models to the biplane radiographs with an accuracy of 0.3 mm for translation and 0.8° for rotation. Translation of the center of the femoral head relative to the center of the acetabulum and rotation of the femur relative to the pelvis from neutral to the weightbearing apprehension position were calculated. Sex-based differences in hip kinematics were assessed by bivariate linear regression. RESULTS The median (range) translation during the weightbearing apprehension position in females was 0.9 mm (0.2 to 2.7 mm), which was less than in the 1.3 mm (0.2 to 2.6 mm) translation found in males (median difference of 0.5 mm; p = 0.04). The median absolute side-to-side difference in translation during the pivot was 1.4 mm (0.1 to 3.8 mm) in females and 1.3 mm (0.1 to 4.4 mm) in males. CONCLUSION These findings demonstrate that the femoral head translates the same under bodyweight loading as previously observed during supine exam, showing the inherent stability of the hip with no history of surgery or symptomatic pathology. This study also provides normal values for comparison with individuals who have suspected microinstability. Future directions for research include directly comparing biplane radiography to alternative imaging techniques, such as dynamic ultrasound, for identifying hip microinstability and identifying threshold values for symptomatic hip microinstability. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Ethan Ruh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Camille Johnson
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - Naomi Frankston
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McClincy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Öhlin A, Senorski EH, Sansone M, Leff G, Desai N, Lindman I, Ayeni OR, Safran MR. Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint. BMC Musculoskelet Disord 2022; 23:309. [PMID: 35361185 PMCID: PMC8973629 DOI: 10.1186/s12891-022-05269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both non-surgical and surgical treatment for microinstability of the hip joint. METHODS A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment. DISCUSSION It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications. TRIAL REGISTRATION Clinicaltrials.gov: NCT04934462 . Registered June 22 2021.
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Affiliation(s)
- Axel Öhlin
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden.
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Gretchen Leff
- Department of Physical Therapy, Stanford University, Redwood City, CA, USA
| | - Neel Desai
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Ida Lindman
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
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Physical Examination of the Hip: Assessment of Femoroacetabular Impingement, Labral Pathology, and Microinstability. Curr Rev Musculoskelet Med 2022; 15:38-52. [PMID: 35171468 PMCID: PMC9076795 DOI: 10.1007/s12178-022-09745-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/02/2022]
Abstract
Purpose of Review Determining the correct diagnosis can be challenging in patients presenting with hip pain. The physical examination is an essential tool that can aid in diagnosis of hip pathology. The purpose of this review is to provide an updated summary of recent literature on the physical exam of the hip, particularly as it relates to diagnosis of femoroacetabular impingement (FAI) syndrome, labral injury, and hip microinstability. Recent Findings Physical exam findings consistent with the diagnosis of FAI include reduced supine hip internal rotation and positive flexion-adduction-internal rotation maneuvers. Labral tears can be detected on exam with the Scour test. Studies demonstrate altered hip biomechanics in patients with FAI during activities such as walking and squatting. Those with FAI have slower squat velocities, slower sit-to-stand tests, and increased hip flexion moments during ambulation. Hip microinstability is a dynamic process, which can occur after prior hip arthroscopy. For hip microinstability, the combination of the three following positive tests (anterior apprehension, abduction-extension-external rotation, and prone external rotation) is associated with a 95% likelihood of microinstability as confirmed by examination under anesthesia at the time of surgery. Summary A comprehensive hip physical exam involves evaluation of the hip in multiple positions and assessing hip range of motion, strength, as well as performing provocative testing. A combination of physical exam maneuvers is necessary to accurately diagnose FAI syndrome and labral pathology as individual tests vary in their sensitivity and specificity. While an elevated level of suspicion is needed to diagnose hip microinstability, the provocative tests for microinstability are highly specific.
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Scott CP, d'Hemecourt PA, Miller PE, Sugimoto D, Jackson SS, Kobelski GP, Whitney KE, Stracciolini A. Femoroacetabular translation in female athletes and dancers assessed by dynamic hip ultrasonography. BMJ Open Sport Exerc Med 2021; 7:e001169. [PMID: 34987860 PMCID: PMC8685970 DOI: 10.1136/bmjsem-2021-001169] [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] [Accepted: 11/17/2021] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo compare femoroacetabular (FA) translation between dancers and athletes with hip pain and between dancers with and without hip pain.MethodsIn this cross-sectional study, 171 female athletes and dancers with hip pain underwent dynamic hip ultrasound (DHUS) of FA translation in three positions: neutral (N), neutral with contralateral hip flexion (NF), apprehension position with contralateral hip flexion (EER-F). Multivariable linear regression analysis was used to assess variation in FA translation between dancers and athletes in the presence of age, Beighton score/hypermobility, BMI, radiographic markers of acetabular dysplasia and femoral version angles. Symptomatic dancers were matched to asymptomatic dancer controls on age, height and BMI, and comparison analyses of FA translation were conducted controlling for matched propensity score and Beighton score.ResultsIn the symptomatic cohort, dancers were younger, had higher Beighton scores and were more hypermobile than non-dancers. Dancers also showed greater NF, EER-F and max US–min US (delta) compared with non-dancers (mean 5.4 mm vs 4.4 mm, p=0.02; mean 6.3 mm vs 5.2 mm, p=0.01; 4.2 mm vs 3.6 mm, p=0.03, respectively). Symptomatic dancers showed greater NF and EER-F compared with asymptomatic dancers (mean 5.5 mm vs 2.9 mm, p<0.001; mean 6.3 mm vs 4.2 mm, p<0.001, respectively). Comparison of symptomatic dancers with and without hip dysplasia showed no difference in DHUS measurements.ConclusionDHUS measurements of FA translation are greater in female dancers with hip pain relative to female non-dancer athletes with hip pain and asymptomatic female dancers.
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Affiliation(s)
- Charles P Scott
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre A d'Hemecourt
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Patricia E Miller
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Sarah S Jackson
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Greggory P Kobelski
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Kristin E Whitney
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Andrea Stracciolini
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Buzzatti L, Keelson B, Vanlauwe J, Buls N, De Mey J, Vandemeulebroucke J, Cattrysse E, Scheerlinck T. Evaluating lower limb kinematics and pathology with dynamic CT. Bone Joint J 2021; 103-B:822-827. [PMID: 33934642 DOI: 10.1302/0301-620x.103b5.bjj-2020-1064.r2] [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] [Indexed: 01/14/2023]
Abstract
Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article: Bone Joint J 2021;103-B(5):822-827.
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Affiliation(s)
- Luca Buzzatti
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Benyameen Keelson
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Johan Vanlauwe
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Erik Cattrysse
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Woodward RM, Vesey RM, Bacon CJ, White SG, Brick MJ, Blankenbaker DG. Microinstability of the hip: a systematic review of the imaging findings. Skeletal Radiol 2020; 49:1903-1919. [PMID: 32583134 DOI: 10.1007/s00256-020-03516-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To undertake a systematic review of the morphologic features associated with hip microinstability and determine whether there are suggestive or diagnostic imaging findings. METHODS Four electronic databases were searched up to September 2019 to identify original research reporting morphologic features in individuals with either a clinical diagnosis of hip microinstability (instability without overt subluxation/dislocation) or those with symptomatic laxity demonstrated on imaging (increased femoral head translation/distraction or capsular volume). Studies focussing on individuals with pre-existing hip conditions (including definite dysplasia (lateral centre edge angle < 20°), significant trauma, previous dislocation or surgery were excluded. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS Twenty-two studies met inclusion criteria (clinical diagnosis of microinstability n = 15 and demonstration of laxity n = 7). Imaging information gathered from the studies includes radiographs (n = 14), MRI (n = 6), MR arthrography (n = 4), CT (n = 1) and intraoperative examination. Most studies exhibited design features associated with an overall high or unclear risk of bias. Some dysplastic features are associated with microinstability or laxity reference measures; however, microinstability is frequently diagnosed in those with a lateral centre edge angle > 25°. Other associated imaging findings reported include impingement morphology, anterior labral tearing, femoral head chondral injury, ligamentum teres tears and capsular attenuation. CONCLUSIONS The current literature does not provide strong evidence for imaging features diagnostic of microinstability. In the appropriate clinical context, dysplastic morphology, anterior labral tears and ligamentum teres tears may be suggestive of this condition although further research is needed to confirm this. PROSPERO REGISTRATION CRD42019122406.
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Affiliation(s)
- Rebecca M Woodward
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.,Auckland Radiology Group, Auckland, New Zealand
| | - Renuka M Vesey
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Catherine J Bacon
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.,Orthosports North Harbour Ltd., Millennium Institute of Sport & Health, Auckland, New Zealand
| | - Steve G White
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Matthew J Brick
- Orthosports North Harbour Ltd., Millennium Institute of Sport & Health, Auckland, New Zealand
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Bixby SD, Millis MB. The borderline dysplastic hip: when and how is it abnormal? Pediatr Radiol 2019; 49:1669-1677. [PMID: 31686172 DOI: 10.1007/s00247-019-04468-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Borderline acetabular dysplasia refers to mildly sub-normal patterns of acetabular shape and coverage that might predispose children to mechanical dysfunction and instability. Borderline dysplasia generally includes children with a lateral center edge angle (CEA) of 18-24°. Some children with borderline radiographic measurements have normal joint mechanics and function while others benefit from acetabular reorienting surgery. Although radiographic findings of borderline dysplasia might suggest instability, the ultimate diagnosis is based on history and physical exam in addition to imaging. Children with borderline acetabular dysplasia sometimes benefit from other cross-sectional imaging studies such as MR imaging to evaluate for secondary evidence of instability, including damage along the acetabular rim, or labral degeneration and hypertrophy. CT is also helpful for depiction of 3-D acetabular morphology for preoperative assessment and planning. Pediatric radiologists are often the first to identify borderline or mild dysplasia on radiographs. It is imperative that pediatric radiologists serve as effective consultants and offer appropriate recommendations as part of a cohesive multidisciplinary approach to this complex patient population.
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Affiliation(s)
- Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, Main 2, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Michael B Millis
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
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