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Hobson TE, Metz AK, Bellendir TR, Froerer DL, Rosenthal RM, Hunter CDR, Featherall J, Maak TG, Aoki SK. Short-term Outcomes After Hip Arthroscopic Surgery in Patients Participating in Formal Physical Therapy Versus a Home Exercise Program: A Prospectively Enrolled Cohort Analysis. Am J Sports Med 2024; 52:2021-2028. [PMID: 38857043 DOI: 10.1177/03635465241252981] [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] [Indexed: 06/11/2024]
Abstract
BACKGROUND Physical therapy is frequently utilized in the postoperative care of femoroacetabular impingement syndrome (FAIS). There has been limited research into the efficacy of a structured home exercise program (HEP) compared with formal physical therapy (FPT) in this patient population. PURPOSE/HYPOTHESIS The purpose was to evaluate the short-term outcomes of patients utilizing FPT versus an HEP after hip arthroscopic surgery for FAIS. It was hypothesized that both groups would show similar improvements regarding outcome scores, which would improve significantly compared with their preoperative scores. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing hip arthroscopic surgery for FAIS at a single center between October 2020 and October 2021 were prospectively enrolled. Patients were allowed to self-select FPT or an HEP and were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. The survey included the Single Assessment Numeric Evaluation, visual analog scale for pain, 12-item International Hip Outcome Tool, Patient-Reported Outcomes Measurement Information System Physical Function, and patient satisfaction with physical therapy and overall care. Statistical analysis was conducted between the 2 groups and within groups to compare preoperative and postoperative scores. RESULTS The patients' mean age was 32.6 ± 10.4 years, with 47.2% being female and 57.4% choosing the HEP. At 12 months postoperatively, no significant differences were reported between the FPT and HEP groups regarding the Single Assessment Numeric Evaluation score (P = .795), visual analog scale for pain score (P > .05), Patient-Reported Outcomes Measurement Information System Physical Function T-score (P = .699), 12-item International Hip Outcome Tool score (P = .582), and patient satisfaction (P > .05). Outcome scores at 12 months postoperatively were significantly improved from the preoperative scores across all measures in both groups (P < .001). CONCLUSION There were no significant differences regarding patient outcomes between FPT and the HEP at 1-year follow-up after hip arthroscopic surgery for FAIS when patients selected their own treatment, with both groups demonstrating significant improvements in their outcome scores from their preoperative values. These findings suggest that a structured HEP may be a viable alternative to FPT after hip arthroscopic surgery in patients who prefer a self-directed rehabilitation program.
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Affiliation(s)
- Taylor E Hobson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Allan K Metz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Trina R Bellendir
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Reece M Rosenthal
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Collin D R Hunter
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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Lamo-Espinosa JM, Gómez-Álvarez J, Pascual Roquet-Jalmar E, Iribarren A, Recke A, Roa MC, Valentí-Azcárate A, Granero-Moltó F, San-Julián M. Femoroacetabular Impingement and the Effect of Osteochondroplasty on Hip Osteoarthritis Prevention: The Pandora's Box Opening Process. Cartilage 2024; 15:120-129. [PMID: 37723972 PMCID: PMC11368905 DOI: 10.1177/19476035231191202] [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: 04/02/2023] [Revised: 07/15/2023] [Accepted: 07/15/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE This study was conducted to assess the effect of osteochondroplasty on osteoarthritis (OA) prevention, comparing radiological evolution between identical hips from the same patient who had undergone unilateral surgery. DESIGN We retrospectively reviewed radiological evolution between hips with similar shape from the same patient who had undergone unilateral surgery. In all, 56 FAI patients (112 hips) with a mean age of 42.18 ± 9.16 years and had undergone unilateral arthroscopy treatment have been included. Four independent researchers measured Wiberg, Acetabular and Alpha angles, Extrusion index, and Tönnis classification preoperatively to verify that operated and non-operated hips had the same shape. OA evolution was assessed by joint space width (JSW) in 3 different articular points and Tönnis classification. RESULTS No preoperative anatomical differences were present between groups (P > 0.05). At the end of follow-up (31.9 months), a decrease of JSW in the 3 points measured was found in OP hips (OP vs. N-OP; P < 0.01). These results were correlated with changes in the proportion of patients who progressed to grade III in Tönnis classification (from 1.3% preoperative to 23.2% at the end of follow-up). CONCLUSIONS Osteochondroplasty and labrum procedures were not associated with OA prevention. The OP hips showed a faster OA degeneration, which was not seen in the N-OP. These results will encourage hip surgeons to perform further investigations to avoid the "Pandora's Box Opening Process."
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Affiliation(s)
- José M. Lamo-Espinosa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
- Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
- Regenerative Medicine Program, Instituto de Investigación Sanitaria de Navarra (Idisna), Cima Universidad de Navarra, Pamplona, Spain
| | - Jorge Gómez-Álvarez
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Asier Iribarren
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Anne Recke
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Cruz Roa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Andrés Valentí-Azcárate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Froilán Granero-Moltó
- Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
- Regenerative Medicine Program, Instituto de Investigación Sanitaria de Navarra (Idisna), Cima Universidad de Navarra, Pamplona, Spain
| | - Mikel San-Julián
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
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Hip joint range of motion is restricted by pain rather than mechanical impingement in individuals with femoroacetabular impingement syndrome. Arch Orthop Trauma Surg 2022; 142:1985-1994. [PMID: 34585303 PMCID: PMC9296409 DOI: 10.1007/s00402-021-04185-4] [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] [Received: 03/08/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Discerning whether range of motion (ROM) is restricted by morphology or other pain sources is challenging in patients with femoroacetabular impingement syndrome (FAIS). Computed tomography (CT) motion simulation provides a hypothetical ROM based on morphology. This study aimed to explore associations between ROM measured using CT motion simulation and maximum passive ROM measured clinically using three dimensional (3D) motion analysis in patients with FAIS, prior to and post arthroscopic hip surgery. MATERIALS AND METHODS Eight males with FAIS (in total 12 hip joints) were included in this explorative feasibility study. Participants were examined using CT according to a low-dose protocol prior to and 7-months post arthroscopic surgery. Software was used to simulate at which ROM the impingement would occur. With the hip in 90 degrees' flexion, maximum passive range of internal hip rotation, and maximum passive internal hip rotation coupled with adduction was examined clinically using 3D motion analysis pre- and postoperatively. Spearman rank correlation coefficients and linear regressions examined associations between methods. RESULTS Preoperatively, the correlation between maximum internal hip rotation measured using CT motion simulation and 3D motion analysis was strong (r = 0.71, p = 0.009). Linear regressions demonstrated that maximal internal rotation measured using CT motion simulation was predominantly larger than when measured using 3D motion analysis. Postoperatively, and when maximum internal rotation was coupled with adduction, no correlations were found between the two methods. CONCLUSIONS The hypothetical morphology restricted ROM is larger than clinically assessed pain restricted ROM, both prior to and post hip arthroscopy. These findings suggest that ROM is restricted by pain rather than mechanical, morphology-based impingement in individuals with FAIS.
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Kemp JL, Østerås N, Mathiessen A, Nordsletten L, Agricola R, Waarsing JH, Heerey JJ, Risberg MA. Relationship between cam morphology, hip symptoms, and hip osteoarthritis: the Musculoskeletal pain in Ullersaker STudy (MUST) cohort. Hip Int 2021; 31:789-796. [PMID: 32701366 DOI: 10.1177/1120700020943853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The primary aim of this study was to determine the prevalence of cam morphology in a cohort of people aged 40-55 years. Secondary aims were to: (1) determine differences in participant characteristics, physical impairments, radiographic and ultrasound appearances of people with and without cam morphology; and (2) explore associations between cam morphology and radiographic measures of hip osteoarthritis (OA). METHODS 107 people (68% women; 49 ± 4 years) from the Musculoskeletal pain in Ullensaker (MUST) Study underwent the clinical and imaging examinations. Examinations included questionnaires, hip range, functional task performance, pelvic radiographs and ultrasound. Alpha angle and radiographic hip OA (Kellgren Lawrence (KL) and minimal joint space (MJS)) were determined. RESULTS The prevalence of cam morphology was 42% and was bilateral in 47%. People with cam morphology were 6 times more likely to have a KL score ⩾2 (adjusted odds ratio [95% confidence intervals, p-value]) 6.386 [1.582-37.646, p = 0.012]) and 4 times more likely to have MJS <2.0 mm (adjusted odds ratio 4.032 [1.031-12.639, p = 0.045]). The prevalence of radiographic OA features ranged from 4-13% in people with cam morphology, and 0-3% in those without. Those with cam morphology also demonstrated reduced hip flexion and rotation range (p = 0.018-0.036) compared with those without. There was no association between ultrasonic features and patient reported outcomes, and cam morphology. CONCLUSIONS In a cohort aged 40-55 years, the prevalence of cam morphology was high (42%), with a significant relationship between cam morphology and radiographic measures of hip OA. Further longitudinal studies should explore the relationship between cam morphology and hip OA in younger people.
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Weinhandl JT, Irmischer BS, Bennett HJ. The effects of sex and landing task on hip mechanics. Comput Methods Biomech Biomed Engin 2021; 24:1819-1827. [PMID: 34665980 DOI: 10.1080/10255842.2021.1921163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prevalence of femoroacetabular impingement syndrome is common in cutting sports. A first step to understanding the relationship between cutting sports and the development of femoroacetabular impingement is to investigate hip joint contact forces during such tasks. The purpose of this study was to explore sex and task differences in hip joint contact forces, estimated through musculoskeletal modeling, during single-leg drop landings and land-and-cuts. Kinematics and ground reaction forces were obtained from 38 adults performing drop landings and land-and-cut tasks. Simulations were performed in OpenSim to estimate lower extremity muscle forces and hip joint contact forces. Statistical parametric mapping was used to compare hip joint force waveforms between sex and task. There were no sex differences in hip joint forces, but landing trials were characterized by increased hip joint forces compared to land-and-cut trials. The hip joint force estimates obtained the current study could be used in future finite element models that incorporate bone growth models to understand the development of femoroacetabular impingement and design possible compensatory exercises.
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Affiliation(s)
- Joshua T Weinhandl
- Department of Kinesiology, Recreation, & Sports Studies, The University of Tennessee, Knoxville, TN, USA
| | - Bobbie S Irmischer
- School of Computer Science and Mathematics, University of Central Missouri, Warrensburg, MO, USA
| | - Hunter J Bennett
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA
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Terrell SL, Lynch J. Training Load Monitoring and Improved Movement Literacy-Overlooked Strategies for Femoroacetabular Impingement Syndrome Injury Incidence in Youth Athletes. Curr Sports Med Rep 2021; 20:503-505. [PMID: 34622811 DOI: 10.1249/jsr.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sara Lynn Terrell
- Exercise Science Program, School of Nursing and Health Sciences, Florida Southern College, Lakeland, FL
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Wörner T, Eek F, Kraus-Schmitz J, Sansone M, Stålman A. Rapid decline of yearly number of hip arthroscopies in Sweden: a retrospective time series of 6,105 hip arthroscopies based on a national patient data register. Acta Orthop 2021; 92:562-567. [PMID: 34018896 PMCID: PMC8519534 DOI: 10.1080/17453674.2021.1928396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Hip arthroscopies (HAs) have increased exponentially worldwide and are expected to continue rising. We describe time trends in HA procedures in Sweden (10 million inhabitants) between 2006 and 2018 with a focus on procedure rates, surgical procedures, and patient demographics such as age and sex distribution.Patients and methods - We retrospectively collected data from the Swedish National Patient Register (NPR) for all surgeries including surgical treatment codes considered relevant for HA from 2006 to 2018. Surgical codes were validated through a multiple-step procedure and classified into femoroacetabular impingement syndrome (FAIS) related or non-FAIS related procedure. Frequencies, sex differences, and time trends of surgical procedures and patient demographics are presented.Results - After validation of HA codes, 6,105 individual procedures, performed in 4,924 patients (mean age 34 years [SD 12]) were confirmed HAs and included in the analysis. Yearly HA procedure rates increased from 15 in 2006 to 884 in 2014, after which a steady decline was observed with 469 procedures in 2018. The majority (65%) of HAs was performed in males. Male patients were younger, and surgeries on males more frequently included an FAIS-related procedure.Interpretation - Similar to previous studies in other parts of the world, we found dramatic increases in HA procedures in Sweden between 2006 and 2014. Contrary to existing predictions, HA rates declined steadily after 2014, which may be explained by more restrictive patient selection based on refined surgical indications, increasing evidence, and clinical experience with the procedure.
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Affiliation(s)
- Tobias Wörner
- Department of Health Sciences, Lund University, Lund,Capio Artro Clinic, Stockholm,Correspondence:
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund
| | - Jesper Kraus-Schmitz
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm,Department of Orthopaedics, Skåne University Hospital, Malmö
| | - Mikael Sansone
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Stålman
- Capio Artro Clinic, Stockholm,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
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Terrell SL, Olson GE, Lynch J. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. J Athl Train 2021; 56:31-45. [PMID: 33112956 DOI: 10.4085/1062-6050-0488.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) is characterized by premature contact of the femur and acetabulum during hip motion. Morphologic variations of FAIS present as either aspherical femoral deformity (cam femoroacetabular impingement) or overcoverage (pincer femoroacetabular impingement) or both. Patients with FAIS often describe discomfort with hip flexion, adduction, and internal rotation. The use of hip arthroscopy to treat FAIS has risen substantially over the last 15 years. Given that one practice domain of the athletic training profession involves injury prevention and wellness protection, optimal FAIS treatment and management strategies warrant discussion. Sports medicine professionals often help patients with FAIS explore nonoperative exercise strategies and direct rehabilitation exercises for those who pursue surgery. Both approaches demonstrate key pillars of exercise program design, which include postural control, core stabilization, hip strength and motor control, and mobility. The purpose of this article is 2-fold: to present an overview of FAIS, including common diagnostic strategies, and commonalities in therapeutic approaches between nonoperative and postoperative rehabilitation for the treatment and management of patients with FAIS.
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Affiliation(s)
- Sara Lynn Terrell
- Department of Exercise Science, Florida Southern College, Lakeland.,School of Nursing and Health Sciences, Florida Southern College, Lakeland
| | - Gayle E Olson
- Department of Athletics, Florida Southern College, Lakeland
| | - James Lynch
- School of Nursing and Health Sciences, Florida Southern College, Lakeland
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Benefits of a Specific and Supervised Rehabilitation Program in Femoroacetabular Impingement Patients Undergoing Hip Arthroscopy: A Randomized Control Trial. J Clin Med 2021; 10:jcm10143125. [PMID: 34300291 PMCID: PMC8307353 DOI: 10.3390/jcm10143125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
(1) To assess the efficacy of a specific rehabilitation protocol for femoroacetabular impingement syndrome (FAIS), patients who underwent hip arthroscopy (HA) were compared with a control group. (2) Patients with symptomatic FAIS who were scheduled for HA were randomized either to a control group (n = 45, 66.6% men, 41.8 ± 12.4 years) following a general post-surgical treatment protocol or to an experimental group (n = 45, 71.2% men, 40.9 ± 7.6 years) following a specific rehabilitation protocol supervised by a physiotherapist. Range of motion (ROM), orthopedic tests and pain were assessed immediately before surgery and at 4 and 14 weeks after surgery. The hip functional status was assessed by the modified Harris Hip Score (mHHS) before surgery and at the end of follow-up. (3) At 14 weeks after surgery and compared with the control group, the experimental group showed a lower percentage of positives for hip provocation tests (15.6% vs. 46.6% on Faber test; 15.6% vs. 77.8% on Fadir test; 2.2% vs. 20% on Ober test, experimental vs. control group, p < 0.001), a greater improvement in mHHS (27.2 vs. 10.7 points, p < 0.001) and higher ROM for all the movements evaluated: flexion (99.6 ± 12.2 vs. 89.6 ± 4.5, p < 0.001), extension (20.6 ± 5.8 vs. 13.3 ± 2.6, p < 0.001), adduction (30.6 ± 5.7 vs. 23.4 ± 8.4, p < 0.001), abduction (43.4 ± 10.7 vs. 32.8 ± 8.4, p < 0.001) and both internal (28.2 ± 8.5 vs. 18.7 ± 6.1, p < 0.001) and external hip rotation (36.8 ± 9.3 vs. 27.4 ± 5.6. p < 0.001). The pain decreased after surgery for both groups, although the reduction was greater in the experimental group at the end of intervention (13.8 ± 16.1 vs. 34.9 ± 16.3 mm, experimental vs. control group, p < 0.001). (4) The specific and supervised rehabilitation program in patients with FAIS undergoing HA showed better benefits at 14 weeks of treatment than the benefits achieved by a care protocol in terms of pain reduction and recovery of hip motion.
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Hale RF, Melugin HP, Zhou J, LaPrade MD, Bernard C, Leland D, Levy BA, Krych AJ. Incidence of Femoroacetabular Impingement and Surgical Management Trends Over Time. Am J Sports Med 2021; 49:35-41. [PMID: 33226833 PMCID: PMC8025987 DOI: 10.1177/0363546520970914] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a well-known cause of hip pain in adolescents and young adults. However, the incidence in the general population has not been clearly defined. PURPOSE To (1) define the population-based incidence of diagnosis of FAI in patients with hip pain, (2) report the trends in diagnosis of FAI over time, and (3) determine the changes in the rate and type of surgical management over time. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A geographic database was used to identify patients who were 14 to 50 years old with hip pain between the years 2000 and 2016. Chart and radiographic review was performed to determine which patients had FAI. To be included, patients had to have a triad of clinical symptoms, physical examination signs, and imaging findings consistent with FAI. Medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Statistical analysis determined the overall age- and sex-adjusted annual incidence of FAI diagnosis and trends over time. RESULTS There were 1893 patients evaluated with hip pain, and 716 (38%; 813 hips) had diagnosed FAI. The mean ± SD age was 27.2 ± 8.4 years, and 67% were female. The incidence of FAI diagnosis was 54.4 per 100,000 person-years. Female patients had a higher incidence than male patients (73.2 vs 36.1 per 100,000 person-years; P < .01). Incidence of FAI diagnosis were higher from 2010 to 2016 (72.6 per 100,000 person-years; P < .01) as compared with 2005 to 2009 (45.3) and 2000 to 2004 (40.3). Hip arthroscopy, surgical hip dislocation, and periacetabular osteotomy utilization increased from the 2000-2004 to 2010-2016 periods, respectively: 1 (1%) to 160 (20%; P = .04), 2 (1%) to 37 (5%; P = .01), and 1 (1%) to 22 (3%; P = .58). CONCLUSION The overall incidence of FAI diagnosis was 54.4 per 100,000 person-years, and it consistently increased between 2000 and 2016. Female patients had a higher incidence than male patients. The utilization of joint preservation operations, including hip arthroscopy, surgical hip dislocation, and anteverting periacetabular osteotomy, increased over time.
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Affiliation(s)
- Rena F. Hale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Heath P. Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Matthew D. LaPrade
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Devin Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,Address correspondence to Aaron J. Krych, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA ()
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Abstract
Aims Femoroacetabular impingement (FAI) describes abnormal bony contact of the proximal femur against the acetabulum. The term was first coined in 1999; however what is often overlooked is that descriptions of the morphology have existed in the literature for centuries. The aim of this paper is to delineate its origins and provide further clarity on FAI to shape future research. Methods A non-systematic search on PubMed was performed using keywords such as “impingement” or “tilt deformity” to find early anatomical descriptions of FAI. Relevant references from these primary studies were then followed up. Results Although FAI has existed for almost 5,000 years, the anatomical study by Henle in 1855 was the first to describe it in the literature. The relevance of the deformity was not appreciated at the time but this triggered the development of further anatomical studies. Parallel to this, Poland performed the first surgical correction of FAI in 1898 and subsequently, descriptions of similar procedures followed. In 1965, Murray outlined radiological evidence of idiopathic cam-type deformities and highlighted its significance. This led to a renewed focus on FAI and eventually, Ganz et al released their seminal paper that has become the foundation of our current understanding of FAI. Since then, there has been an exponential rise in published literature but finding a consensus, especially in the diagnosis of FAI, has proven to be difficult. Conclusion Current research on FAI heavily focuses on new data, but old evidence does exist and studying it could be equally as important in clarifying the aetiology and classification of FAI. Cite this article: Bone Joint Res 2020;9(9):572–577.
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Affiliation(s)
- Kenki Matsumoto
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Reinhold Ganz
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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Abstract
INTRODUCTION Physiotherapy is a management option for the treatment of femoroacetabular impingement (FAI) syndrome. This study examines the influence of changes in pelvic tilt and hip adduction on the range of motion (ROM) of the hip. METHODS Ten FAI hips were used to simulate impingement at two positions: (1) 20° internal rotation (IR) with 100° flexion and 10° adduction and (2) 40° IR with 35° flexion and 10° adduction; the amount of IR was measured at the point of bony impingement or to the defined limit. Each simulation was performed at neutral and 5° and 10° anterior and posterior pelvic tilt. Then, the hip was placed in 10° of abduction, and all simulations were repeated. RESULTS With neutral pelvic tilt, impingement occurred at 4.3 ± 8.4° of IR at the high-flexion position. An increase in anterior pelvic tilt led to a loss of IR, that is, earlier occurrence of FAI, whereas an increase in posterior pelvic tilt led to an increase in IR, that is, later occurrence of FAI. At the high-flexion position, abduction provided more IR before impingement (neutral: 9.1 ± 5.7°, P < 0.01; 10° anterior tilt: 14.6 ± 5.2°, P < 0.01; 10° posterior tilt: 4.2 ± 3.7° IR, P = 0.01). Placing the hip in abduction and posteriorly tilting the pelvis produce a combined effect that increased IR relative to the neutrally tilted pelvis (5° posterior tilt: 11.4 ± 7.6°, P = 0.01; 10° posterior tilt: 12.8 ± 7.6°, P < 0.01). The ROM in the mid-flexion position was not affected by any combination of pelvic tilt and hip abduction or adduction (average IR: 37.4 ± 5.0°, P > 0.05). CONCLUSIONS Abduction and posterior pelvic tilt increased the impingement-free ROM in the hips with FAI. Thus, rehabilitation aimed at altering the tilt of the pelvis may reduce the frequency of impingement and limit further joint damage.
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Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, Kassarjian A, Mosler AB, Ageberg E, Hölmich P, Warholm KM, Griffin D, Mayes S, Khan KM, Crossley KM, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Di Stasi S, Drew M, Friedman DJ, Freke M, Gojanovic B, Glyn-Jones S, Harris-Hayes M, Hunt MA, Impellizzeri FM, Ishøi L, Jones DM, King MG, Lawrenson PR, Leunig M, Lewis CL, Mathieu N, Moksnes H, Risberg MA, Scholes MJ, Semciw AI, Serner A, Thorborg K, Wörner T, Dijkstra HP. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 54:631-641. [PMID: 31959678 DOI: 10.1136/bjsports-2019-101453] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.
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Affiliation(s)
- Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Orthopaedics, Erasmus MC Center for Groin Injuries, Rotterdam, The Netherlands.,Sports Groin Pain Centre, Aspetar Hospital, Doha, Qatar
| | - Pim van Klij
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Ara Kassarjian
- Elite Sports Imaging SL, Madrid, Spain.,Musculoskeletal Radiology, Corades, LLC, Brookline, MA, United States
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Sport Sciences, Deparment of Health Sciences, Lund University, Lund, Sweden
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Damian Griffin
- Orthopaedics - Medical School, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Mayes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mario Bizzini
- Research, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nancy Bloom
- Physical Therapy, Washington University, St. Louis, Missouri, USA
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland Griffith University, Schoold of Allied Health Sciences, Griffith, Queensland, Australia
| | - Stephanie Di Stasi
- School of Health and Rehabilitation Sciences, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Drew
- Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Research into Sport and Exercise, University of Canberra, Canberra, Bruce, Australian Capital Territory, Australia
| | | | - Matthew Freke
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sion Glyn-Jones
- Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, United Kingdom
| | | | - Michael A Hunt
- Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Loeche-les-Bains, Valais, Switzerland
| | | | - May-Arna Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Mark James Scholes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andreas Serner
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Hendrik Paulus Dijkstra
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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15
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Diamond LE, van den Hoorn W, Bennell KL, Wrigley TV, Hinman RS, O'Donnell J, Hodges PW. Deep hip muscle activation during squatting in femoroacetabular impingement syndrome. Clin Biomech (Bristol, Avon) 2019; 69:141-147. [PMID: 31351343 DOI: 10.1016/j.clinbiomech.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/31/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep hip muscle retraining is a common objective of non-operative management for femoroacetabular impingement (FAI) syndrome. These muscles are considered to have an important role in hip joint stabilization, however, it is unclear whether their function is altered in the presence of hip pathology. This exploratory study aimed to investigate activation patterns of the hip muscles during two squatting tasks in individuals with and without FAI syndrome. METHODS Fifteen individuals with FAI syndrome (symptoms, clinical examination and imaging) and 14 age- and sex-comparable healthy controls underwent testing. Intramuscular fine-wire and surface electrodes recorded electromyographic activity of selected deep and superficial hip muscles during the squatting tasks. Activation patterns from individual muscles were compared between-groups using a wavelet-based linear mixed effects model (P < 0.05). FINDINGS There were no between-group differences for squat depth or speed during descent or ascent for either task. Participants with FAI syndrome exhibited patterns of activation that differed significantly to controls across all muscles (P < 0.05) when squatting using their preferred strategy. Unlike controls, participants with FAI syndrome exhibited a pattern of activation for obturator internus during descent that was similar in amplitude to ascent, despite the contrasting contraction type (i.e. eccentric vs concentric). INTERPRETATION Individuals with FAI syndrome appear to implement a protective strategy as the hip descends towards the impingement position. Future studies should examine patients prospectively to establish whether these strategies are counterproductive for pathology and warrant rehabilitation.
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Affiliation(s)
- Laura E Diamond
- Griffith University, School of Allied Health Sciences, Gold Coast, QLD 4222, Australia; Griffith University, Gold Coast Orthopaedics Research, Engineering & Education Alliance (GCORE), Menzies Health Institute Queensland, Gold Coast, QLD 4222, Australia; The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
| | - Wolbert van den Hoorn
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD 4072, Australia
| | - Kim L Bennell
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, 161 Barry Street, Parkville, VIC 3010, Australia
| | - Tim V Wrigley
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, 161 Barry Street, Parkville, VIC 3010, Australia
| | - Rana S Hinman
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, 161 Barry Street, Parkville, VIC 3010, Australia
| | | | - Paul W Hodges
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, QLD 4072, Australia
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Falotico GG, Arliani GG, Yamada AF, Fernandes ADRC, Ejnisman B, Cohen M. Professional soccer is associated with radiographic cam and pincer hip morphology. Knee Surg Sports Traumatol Arthrosc 2019; 27:3142-3148. [PMID: 29876863 DOI: 10.1007/s00167-018-5008-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 06/01/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Femoroacetabular impingement (FAI) syndrome is characterized by a triad: symptoms, clinical signs and imaging findings. Some individuals, especially athletes, have only imaging alterations. The objective of this study was to evaluate the prevalence of cam and pincer morphology in professional soccer players compared with a control group of non-athletes and to investigate the association between the age at which players start playing competitive soccer more than three times per week and duration of the soccer career with the prevalence of these radiographic findings. METHODS The prevalence of cam and pincer morphology in sixty professional adult male soccer players and thirty-two male controls was determined using pelvic anteroposterior radiography. Data were recorded for all hips and correlated with the age at which the players started competitive soccer practice and with the duration of their soccer career. RESULTS The prevalence of morphological FAI in the soccer players was 92.5% versus 28.1% in the controls (p < 0.001). The duration of the soccer career was positively correlated with the alpha angle (p = 0.033) and negatively correlated with the retroversion index (p = 0.009). The age at which competitive play began was inversely correlated with the alpha angle (p < 0.001). CONCLUSION The study showed a high prevalence of cam and pincer morphology in Brazilian professional soccer players compared with controls. The duration of the soccer career was associated with an increased alpha angle and a decreased retroversion index, and the age at which competitive soccer participation began was negatively associated with alpha angle values. Finally, this manuscript provides data about the association between greater exposure to soccer and cam and pincer morphological changes in the hip; specifically, cam morphology was more common in patients who began participating in sports at earlier ages. This information serves as an alert for coaches of youth teams to manage the training load in youth athletes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Guilherme Guadagnini Falotico
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil.
| | - Gustavo Gonçalves Arliani
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil
| | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil
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17
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Rhon DI, Greenlee TA, Sissel CD, Reiman MP. The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome. BMC Musculoskelet Disord 2019; 20:266. [PMID: 31153368 PMCID: PMC6545211 DOI: 10.1186/s12891-019-2646-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background One of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy. Methods Observational analysis of patients undergoing hip arthroscopy between 2004 and 2013, utilizing the Military Health System Data Repository. Individuals with prior cases of osteoarthritis were excluded. Presence of osteoarthritis was based on diagnostic codes rendered by a medical provider in patient medical records. Adjusted odds ratios (95% CI) for an osteoarthritis diagnosis were reported for relevant clinical and demographic variables. Results Of 1870 participants in this young cohort (mean age 32.2 years), 21.9% (N = 409) had a postoperative clinical diagnosis of hip osteoarthritis within 2 years. The 3 significant predictors in the final model were older age (OR = 1.04; 95%CI = 1.02, 1.05), male sex (OR = 1.31; 95%CI = 1.04, 1.65), and having undergone an additional hip surgery (OR = 2.33; 95% CI = 1.72, 3.16). Military status and post-surgical complications were not risk factors. Conclusion A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy in as little as 2 years. These rates may differ when using alternate criteria to define OA, such as radiographs, and likely underestimate the prevalence. A more comprehensive approach, considering various criteria to detect OA will likely be necessary to accurately identify the true rates. Females were at lower risk, while increasing age and multiple surgeries increased the risk for an OA diagnosis. OA onset still occurs after “hip preservation” surgery in a substantial number of individuals within 2 years. This should be considered when estimating rates of disease prevention after surgery. Prospective trials with sound methodology are needed to determine accurate rates and robust predictors of osteoarthritis onset after hip preservation surgery.
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Affiliation(s)
- Daniel I Rhon
- Physical Performance Service Line, G 3/5/7, US Army Office of the Surgeon General, Falls Church, VA, USA. .,Baylor University, Road, Bldg 2841, Suite 1301; JBSA Fort Sam Houston, Stanley, TX, 3630, USA.
| | - Tina A Greenlee
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, USA
| | | | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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18
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Richardson RS, Lothe K, Sturridge S. Is surgery effective in patients with femoroacetabular impingement syndrome? BMJ 2019; 365:l1359. [PMID: 31000520 DOI: 10.1136/bmj.l1359] [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: 11/04/2022]
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Catelli DS, Kowalski E, Beaulé PE, Smit K, Lamontagne M. Asymptomatic Participants With a Femoroacetabular Deformity Demonstrate Stronger Hip Extensors and Greater Pelvis Mobility During the Deep Squat Task. Orthop J Sports Med 2018; 6:2325967118782484. [PMID: 30038915 PMCID: PMC6050869 DOI: 10.1177/2325967118782484] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Cam-type femoroacetabular impingement (FAI) is a femoral head-neck deformity
that causes abnormal contact between the femoral head and acetabular rim,
leading to pain. However, some individuals with the deformity do not
experience pain and are referred to as having a femoroacetabular deformity
(FAD). To date, only a few studies have examined muscle activity in patients
with FAI, which were limited to gait, isometric and isokinetic hip flexion,
and extension tasks. Purpose: To compare (1) hip muscle strength during isometric contraction and (2) lower
limb kinematics and muscle activity of patients with FAI and FAD
participants with body mass index–matched healthy controls during a deep
squat task. Study Design: Controlled laboratory study. Methods: Three groups of participants were recruited: 16 patients with FAI (14 male, 2
female; mean age, 38.5 ± 8.0 years), 18 participants with FAD (15 male, 3
female; mean age, 32.5 ± 7.1 years), and 18 control participants (16 male, 2
female; mean age, 32.8 ± 7.0 years). Participants were outfitted with
electromyography electrodes on 6 muscles and reflective markers for motion
capture. The participants completed maximal strength tests and performed 5
deep squat trials. Muscle activity and biomechanical variables were
extrapolated and compared between the 3 groups using 1-way analysis of
variance. Results: The FAD group was significantly stronger than the FAI and control groups
during hip extension, and the FAD group had greater sagittal pelvic range of
motion and could squat to a greater depth than the FAI group. The FAI group
activated their hip extensors to a greater extent and for a longer period of
time compared with the FAD group to achieve the squat task. Conclusion: The stronger hip extensors of the FAD group are associated with greater
pelvic range of motion, allowing for greater posterior pelvic tilt, possibly
reducing the risk of impingement while performing the squat, and resulting
in a greater squat depth compared with those with symptomatic FAI. Clinical Relevance: The increased strength of the hip extensors in the FAD group allowed these
participants to achieve greater pelvic mobility and a greater squat depth by
preventing the painful impingement position. Improving hip extensor strength
and pelvic mobility may affect symptoms for patients with FAI.
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Affiliation(s)
- Danilo S Catelli
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Erik Kowalski
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
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Jakobsen SS, Overgaard S, Søballe K, Ovesen O, Mygind-Klavsen B, Dippmann CA, Jensen MU, Stürup J, Retpen J. The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip. EFORT Open Rev 2018; 3:408-417. [PMID: 30233816 PMCID: PMC6129960 DOI: 10.1302/2058-5241.3.170042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI).Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain.Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis.Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO).FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery.If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO.THA can be performed following PAO with outcomes similar to a primary THA.Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears. Cite this article: EFORT Open Rev 2018;3:408-417. DOI: 10.1302/2058-5241.3.170042.
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Affiliation(s)
| | - Søren Overgaard
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark
| | - Ole Ovesen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | | | | | | | - Jens Stürup
- Department of Orthopaedics, National University Hospital, Denmark
| | - Jens Retpen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Gentofte, Denmark
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Translation, Cross-cultural Adaptation, and Validation of the Dutch International Hip Outcome Tool-33 (iHOT-33 NL) in Young, Physically Active Individuals With Symptomatic Hip Joint Pathology. J Orthop Sports Phys Ther 2018; 48:289-298. [PMID: 29548273 DOI: 10.2519/jospt.2018.7610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Prospective cohort. Background The international Hip Outcome Tool-33 (iHOT-33), developed in English, has been shown to be a valid and reliable questionnaire for young, physically active individuals with symptomatic hip joint pathology. Objectives To translate and validate the iHOT-33 in Dutch (iHOT-33 NL) in the target population. Methods Translation and cross-cultural adaptation of the iHOT-33 were performed following existing guidelines. Young to middle-aged (18-50 years), active (Tegner activity score of 3 or greater) individuals presenting with symptomatic hip joint-related pain (numeric pain-rating score of 1 or greater) in a primary health care/hospital setting were included. The iHOT-33 NL, Hip disability and Osteoarthritis Outcome Score (HOOS), European Quality of Life-5 Dimensions questionnaire (EQ-5D), numeric pain-rating score, and Global Perceived Effect score were completed by 214 patients. Results The intraclass correlation coefficient for test-retest reliability was 0.92 (95% confidence interval: 0.88, 0.94). Smallest detectable changes at individual and group levels were, respectively, 16.7 and 1.1 points. The Cronbach alpha was .9. Principal-component analysis revealed 4 domains of the iHOT-33 NL. Of the hypotheses used for construct validity, 87% were confirmed. No floor and ceiling effects were detected for the iHOT-33 NL total score. The minimal important change was 10.7 points. Conclusion The iHOT-33 NL is a reliable and valid patient-reported outcome questionnaire for young, physically active individuals with symptomatic hip joint pathology. It can be used in research and clinical settings. J Orthop Sports Phys Ther 2018;48(4):289-298. doi:10.2519/jospt.2018.7610.
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Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther 2018; 48:239-249. [PMID: 29510653 DOI: 10.2519/jospt.2018.7850] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Groin pain is common in athletes who participate in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there has been little agreement regarding terminology, definitions, and classification of groin pain in athletes. This has made clear communication between clinicians difficult, and the results of research difficult to interpret and implement into practice. However, during the past decade, the field has evolved rapidly, and an evidence-based understanding is now emerging. This clinical commentary discusses the clinical examination (subjective history, screening, physical examination); imaging; testing of impairments, function, and performance; and management of athletes with groin pain in an evidence-based framework. J Orthop Sports Phys Ther 2018;48(4):239-249. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7850.
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Harris JD. Editorial Commentary: A Hip Scope Scoping Review on Surgical Outcome Reporting-If You Want to Know the Answer, You Have to Ask the Question. Arthroscopy 2018; 34:1329-1331. [PMID: 29622264 DOI: 10.1016/j.arthro.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 02/06/2023]
Abstract
The existing literature on subjects with femoroacetabular impingement syndrome undergoing arthroscopic or open hip preservation surgery reveals that outcome reporting is heterogeneous. There is significant inconsistency in patient-reported outcome scores collected, symptoms and complaints assessed, clinical signs evaluated, and pre- and postoperative imaging metrics measured.
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Is Bony Hip Morphology Associated With Range of Motion and Strength in Asymptomatic Male Soccer Players? J Orthop Sports Phys Ther 2018; 48:250-259. [PMID: 29548272 DOI: 10.2519/jospt.2018.7848] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional cohort study. Objectives To investigate the relationship between musculoskeletal screening findings and bony hip morphology in asymptomatic male soccer players. Background Athletes with femoroacetabular impingement (FAI) syndrome have cam and/or pincer morphology, pain on orthopaedic testing, and often reduced hip range of motion (ROM) and strength. However, cam and pincer morphology is also common in asymptomatic hips. Therefore, it is currently unknown whether the ROM and strength deficits observed in athletes with FAI syndrome result from the variance in their bony hip morphology or from their hip condition. Methods Male professional soccer players in Qatar were screened specifically for hip/groin pain in 2 consecutive seasons. The screening battery included pain provocation, ROM and strength tests, and hip radiographs. Univariate and multivariate regression analyses, using generalized estimating equations, evaluated the relationship between musculoskeletal screening findings and each bony hip morphological variant (cam, large cam, pincer, and acetabular dysplasia). Results Asymptomatic hips with cam and large cam morphology were associated with lower internal rotation ROM and bent-knee fall-out, and with a higher likelihood of pain on provocation testing. Pincer morphology was associated with lower abduction ROM and higher abduction strength. Acetabular dysplasia was associated with higher abduction ROM. Each association was weak and demonstrated poor or failed discriminatory power. Conclusion Bony hip morphology is associated with hip joint ROM and abduction strength, but musculoskeletal screening tests have a poor ability to discriminate between the different morphologies. J Orthop Sports Phys Ther 2018;48(4):250-259. doi:10.2519/jospt.2018.7848.
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Trunk, pelvis and hip biomechanics in individuals with femoroacetabular impingement syndrome: Strategies for step ascent. Gait Posture 2018; 61:176-182. [PMID: 29353742 DOI: 10.1016/j.gaitpost.2018.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoroacetabular impingment (FAI) syndrome is common among young active adults and a proposed risk factor for the future development of hip osteoarthritis. Pain is dominant and drives clinical decision-making. Evidence for altered hip joint function in this patient population is inconsistent, making the identification of treatment targets challenging. A broader assessment, considering adjacent body segments (i.e. pelvis, trunk) and individual movement strategies, may better inform treatment programs. This exploratory study aimed to compare trunk, pelvis, and hip biomechanics during step ascent between individuals with and without FAI syndrome. METHODS Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery, and 11 age-, and sex-comparable pain- and disease-free individuals, underwent three-dimensional motion analysis during a step ascent task. Trunk, pelvis and hip biomechanics were compared between groups. RESULTS Participants with FAI syndrome exhibited altered ipsilateral trunk lean and pelvic rise towards the symptomatic side during single-leg support compared to controls. Alterations were not uniformly adopted across all individuals with FAI syndrome; those who exhibited more pronounced alterations to frontal plane pelvis control tended to report pain during the task. There were minimal between-group differences for hip biomechanics. CONCLUSION Exploratory data suggest biomechanics at the trunk and pelvis during step ascent differ between individuals with and without FAI syndrome. Those with FAI syndrome implement a range of proximal strategies for task completion, some of which may have relevance for rehabilitation. Longitudinal investigations of larger cohorts are required to evaluate hypothesized clinical and structural consequences.
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Kaya M. Impact of extra-articular pathologies on groin pain: An arthroscopic evaluation. PLoS One 2018; 13:e0191091. [PMID: 29324877 PMCID: PMC5764340 DOI: 10.1371/journal.pone.0191091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose For patients who have anterior hip pain evaluated by Patrick’s test and tenderness at Scarpa’s triangle, we perform periarticular debridement based on the hypothesis that extra-articular pathologies are responsible for the hip pain. The purpose of this study was to categorize the endoscopic extra-articular findings and to evaluate the clinical significance of periarticular pathologies in anterior hip pain. Methods Arthroscopic findings of 77 patients who underwent periarthritic debridement were evaluated. As extra-articular pathologies, injuries of the direct head and reflective head of the rectus femoris muscle were evaluated. A thin layer of fat tissue normally exists on the anterior inferior iliac spine (AIIS), the attachment site of the direct head of the rectus femoris muscle. The macroscopic appearance of the fat pad on the AIIS was categorized as normal, blood vessel-rich adipose tissue or adipose tissue with fibrosis or scar formation and histologically confirmed. Adhesion of gluteal muscles to the joint capsule was also evaluated. Results Of the 77 patients, 75 had rupture of the direct head of the rectus femoris. In contrast, rupture of the reflective head was extremely rare. Seven patients had a normal fat pad on the AIIS, 11 had blood vessel-rich adipose tissue and 55 had adipose tissue with fibrosis. Fat tissue was completely replaced by fibrous scar tissue in another 4 patients. In 64 patients, adhesion between the anterior joint capsule and gluteus muscles was marked. Groin pain disappeared soon after the operation even when labral tears were not repaired and all patients returned to daily life and sports activities within 2 weeks after operation. Conclusion Rectus femoris tendinosis, fibrosis of the AIIS fat pad, and adhesion of gluteal and rectus femoris muscles are common extra-articular pathologies in patients with anterior hip pain. Management of only these lesions induces rapid relief of anterior hip pain even in the absence of labral tear repair. My observations suggest that it is desirable to be aware of the presence of periarticular pathologies as a cause of groin pain.
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Affiliation(s)
- Mitsunori Kaya
- Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
- * E-mail:
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27
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Abstract
Groin pain is a catch all phrase used to define a common set of symptoms that affect many individuals. It is a common condition affecting sportsmen and women (1, 2) and is often referred to as the sportsman groin (SG). Multiple surgical operations have been developed to treat these symptoms yet no definitive imaging modalities exist to diagnose or predict prognosis. This article aims to discuss the anatomy of the groin, suggest a biomechanical pathophysiology and outline a logical surgical solution to treat the underlying pathology. A systematic clinical and imaging approach with inguinal ligament and pubic specific MRI assessment, can result in accurate selection for intervention. Close correlation with clinical examination and imaging in series is recommended to avoid misinterpretation of chronic changes in athletes.
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Newcomb NRA, Wrigley TV, Hinman RS, Kasza J, Spiers L, O'Donnell J, Bennell KL. Effects of a hip brace on biomechanics and pain in people with femoroacetabular impingement. J Sci Med Sport 2017; 21:111-116. [PMID: 29074345 DOI: 10.1016/j.jsams.2017.09.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 06/02/2017] [Accepted: 09/22/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study evaluates whether hip bracing in patients with femoroacetabular impingement (FAI) (a) immediately reduces range of hip internal rotation, flexion, adduction, and pain during functional tasks; and (b) improves patient-reported outcomes when worn daily over 4 weeks. DESIGN Within-participant design followed by a case series. METHODS Twenty-five adults with symptomatic FAI underwent 3D kinematic assessment with and without a hip brace during single-leg squat, double-leg squat, stair ascent, and stair descent. A subset of this population (n=17) continued to wear the brace daily for 4-weeks. A linear mixed statistical model was used to assess pain and kinematic differences between the braced and unbraced conditions at baseline testing. Patient-reported outcomes (NRS pain, iHot-33 and HAGOS questionnaires) at 4-weeks were compared to baseline using paired t-tests. RESULTS Bracing resulted in significant but small reductions in peak hip flexion ranging between 5.3° (95% CI 0.8°-9.7°) and 5.6° (95% CI 1.1°-10.0°), internal rotation ranging between 2.5° (95% CI 0.6°-4.4°) and 6.4° (95% CI 4.5°-8.2°), and adduction ranging between 2.2° (95% CI 0.5°-3.8°) and 3.3° (95% CI 1.6°-5.0°) during all tasks, except flexion during single-leg squat, compared with the unbraced condition; pain was not significantly improved with the brace. Bracing over four weeks did not significantly change patient-reported outcomes. CONCLUSIONS Bracing subtly limited impinging hip movements during functional tasks, but did not immediately reduce pain or improve patient-reported clinical outcomes after 4 weeks in a young adult cohort with long-standing FAI.
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Affiliation(s)
- Nicolas R A Newcomb
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
| | - Tim V Wrigley
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - Libby Spiers
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
| | | | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia.
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29
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O’Sullivan K, Darlow B, O’Sullivan P, Forster BB, Reiman MP, Weir A. Imaging for hip-related groin pain: don’t be hip-notised by the findings. Br J Sports Med 2017; 52:551-552. [DOI: 10.1136/bjsports-2017-097889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reiman MP, Thorborg K, Goode AP, Cook CE, Weir A, Hölmich P. Diagnostic Accuracy of Imaging Modalities and Injection Techniques for the Diagnosis of Femoroacetabular Impingement/Labral Tear: A Systematic Review With Meta-analysis. Am J Sports Med 2017; 45:2665-2677. [PMID: 28129509 DOI: 10.1177/0363546516686960] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diagnosing femoroacetabular impingement/acetabular labral tear (FAI/ALT) and subsequently making a decision regarding surgery are based primarily on diagnostic imaging and intra-articular hip joint injection techniques of unknown accuracy. PURPOSE Summarize and evaluate the diagnostic accuracy and clinical utility of various imaging modalities and injection techniques relevant to hip FAI/ALT. STUDY DESIGN Systematic review with meta-analysis. METHODS A computer-assisted literature search was conducted of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of hip joint pathologic changes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS) tool. Random effects models were used to summarize sensitivities (SN), specificities (SP), likelihood ratios (+LR and -LR), diagnostic odds ratios (DOR), and respective confidence intervals (CI). RESULTS The search strategy and assessment for risk of bias revealed 25 articles scoring above 10/14 on the items of the QUADAS. Four studies investigated FAI, and the data were not pooled. Twenty articles on ALT qualified for meta-analysis. Pretest probability of ALT in the studies in this review was 81% (72%-88%), while the pretest probability of FAI diagnosis was 74% (95% CI, 51%-91%). The meta-analysis showed that computed tomography arthrography (CTA) demonstrated the strongest overall diagnostic accuracy: pooled SN 0.91 (95% CI, 0.83-0.96); SP 0.89 (95% CI, 0.74-0.97); +LR 6.28 (95% CI, 2.78-14.21); -LR 0.11 (95% CI, 0.06-0.21); and DOR 64.38 (95% CI, 19.17-216.21). CONCLUSION High pretest probability of disease was demonstrated. Positive imaging findings increased the probability that a labral tear existed by a minimal to small degree with the use of magnetic resonance imaging/magnetic resonance angiogram (MRI/MRA) and ultrasound (US) and by a moderate degree for CTA. Negative imaging findings decreased the probability that a labral tear existed by a minimal degree with the use of MRI and US, a small to moderate degree with MRA, and a moderate degree with CTA. CLINICAL RELEVANCE Although findings of the included studies suggested potentially favorable use of these modalities for the diagnosis of ALT and FAI, our results suggest that these findings have limited generalizability and clinical utility given very high pretest prevalence, large confidence intervals, and selection criteria of the studies. Registration: PROSPERO Registration #CRD42015027745.
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Affiliation(s)
- Michael P Reiman
- Duke University Medical Center, Department of Orthopedic Surgery, Durham, North Carolina, USA.,Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C) and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam P Goode
- Duke University Medical Center, Department of Orthopedic Surgery, Durham, North Carolina, USA
| | - Chad E Cook
- Duke University Medical Center, Department of Orthopedic Surgery, Durham, North Carolina, USA
| | - Adam Weir
- AMC, Amsterdam Center of Evidence Based Sports Medicine (ACES), Amsterdam, North Holland, The Netherlands.,Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Diamond LE, Van den Hoorn W, Bennell KL, Wrigley TV, Hinman RS, O'Donnell J, Hodges PW. Coordination of deep hip muscle activity is altered in symptomatic femoroacetabular impingement. J Orthop Res 2017; 35:1494-1504. [PMID: 27513847 DOI: 10.1002/jor.23391] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/05/2016] [Indexed: 02/04/2023]
Abstract
Diagnosis of femoroacetabular impingement (FAI) is increasing, yet the associated physical impairments remain poorly defined. This morphological hip condition can cause joint pain, stiffness, impaired function, and eventually hip osteoarthritis. This exploratory study compared coordination of deep hip muscles between people with and without symptomatic FAI using analysis of muscle synergies (i.e., patterns of activity of groups of muscles activated in synchrony) during gait. Fifteen individuals (11 males) with symptomatic FAI (clinical examination and imaging) and 14 age- and sex-comparable controls without morphological FAI underwent testing. Intramuscular fine-wire and surface electrodes recorded electromyographic activity of selected deep and superficial hip muscles. A non-negative matrix factorization algorithm extracted three synergies which were compared between groups. Information regarding which muscles were activated together in the FAI group (FAI group synergy vector) was used to reconstruct individual electromyography patterns and compare groups. Variance accounted for (VAF) by three synergies was less for the control (94.8 [1.4]%) than FAI (96.0 [1.0]%) group (p = 0.03). VAF of obturator internus was significantly higher in the FAI group (p = 0.02). VAF of the reconstructed individual electromyography patterns with the FAI or control group vector were significantly higher for the FAI group (p < 0.01). Following reconstruction, VAF of quadratus femoris was significantly more reduced in controls (p = 0.04), indicating greater between-subject variability. Coordination of deep hip muscles in the synergy related to hip joint control during early swing differed between groups. This phase involves movement towards the impingement position, which has relevance for the interpretation of synergy differences and potential clinical importance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1494-1504, 2017.
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Affiliation(s)
- Laura E Diamond
- Department of Physiotherapy, Center for Health, Exercise and Sports Medicine, The University of Melbourne, School of Health Sciences, 161 Barry Street, Parkville, Victoria, 3010, Australia
| | - Wolbert Van den Hoorn
- Center of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, 4072, Australia
| | - Kim L Bennell
- Department of Physiotherapy, Center for Health, Exercise and Sports Medicine, The University of Melbourne, School of Health Sciences, 161 Barry Street, Parkville, Victoria, 3010, Australia
| | - Tim V Wrigley
- Department of Physiotherapy, Center for Health, Exercise and Sports Medicine, The University of Melbourne, School of Health Sciences, 161 Barry Street, Parkville, Victoria, 3010, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Center for Health, Exercise and Sports Medicine, The University of Melbourne, School of Health Sciences, 161 Barry Street, Parkville, Victoria, 3010, Australia
| | | | - Paul W Hodges
- Center of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, 4072, Australia
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Casartelli NC, Brunner R, Maffiuletti NA, Bizzini M, Leunig M, Pfirrmann CW, Sutter R. The FADIR test accuracy for screening cam and pincer morphology in youth ice hockey players. J Sci Med Sport 2017; 21:134-138. [PMID: 28669665 DOI: 10.1016/j.jsams.2017.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Aim of this study was to evaluate the flexion-adduction-internal rotation (FADIR) test accuracy for screening cam and pincer morphology in youth male ice hockey players without diagnosed hip disorders. DESIGN Cross-sectional study. METHODS Seventy-four ice hockey players with a mean age of 16 years (range: 13-20 years) were assessed unilaterally. The presence of cam and pincer morphology was evaluated using the FADIR test and magnetic resonance imaging (MRI) (reference standard). Positive FADIR test consisted of groin pain during the maneuver, while positive MRI findings consisted of (1) pure cam, pure pincer or combined morphology and acetabular labral alterations, or (2) pure cam or combined morphology and acetabular labral alterations. Sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. RESULTS For pure cam, pure pincer or combined morphology as positive MRI findings, the FADIR test demonstrated a sensitivity of 41%, specificity of 47%, positive likelihood ratio of 0.78, negative likelihood ratio of 1.24, positive predictive value of 19% and negative predictive value of 73%. For pure cam or combined morphology as positive MRI findings, the FADIR test showed a sensitivity of 60%, specificity of 52%, positive likelihood ratio of 1.24, negative likelihood ratio of 0.78, positive predictive value of 16% and negative predictive value of 89%. CONCLUSIONS The FADIR test is inadequate for screening cam and pincer morphology in youth ice hockey players without diagnosed hip disorders because of the large number of false positive test outcomes.
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Affiliation(s)
- Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Switzerland; Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
| | | | | | - Mario Bizzini
- Human Performance Lab, Schulthess Clinic, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Switzerland
| | - Christian W Pfirrmann
- Department of Radiology, Orthopaedic University Hospital Balgrist, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopaedic University Hospital Balgrist, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
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33
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Reiman MP, Thorborg K, Covington K, Cook CE, Hölmich P. Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome: an international and multi-disciplinary Delphi survey. Knee Surg Sports Traumatol Arthrosc 2017; 25:1975-1986. [PMID: 28271369 DOI: 10.1007/s00167-017-4484-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally defined from international publications and presentations was utilized. RESULTS All six domains (subjective examination, patient-reported outcome measures, physical examination, special tests, physical performance measures, and diagnostic imaging) had at least one descriptor with 75% consensus agreement for diagnosis and assessment of FAIS. Diagnostic imaging was the domain with the highest level of agreement. Domains such as patient-reported outcome measures (PRO's) and physical examination were identified as non-diagnostic measures (rather as assessments of disease impact). CONCLUSION Although it also had the greatest level of variability in description of examination domains, diagnostic imaging continues to be the preeminent diagnostic measure for FAIS. No single domain should be utilized as the sole diagnostic or assessment parameter for FAIS. While not all investigated domains provide diagnostic capability for FAIS, those that do not are able to serve purpose as a measure of disease impact (e.g., impairments and activity limitations). The clinical relevance of this Delphi survey is the understanding that a comprehensive assessment measuring both diagnostic capability and disease impact most accurately reflects the patient with FAIS. LEVEL OF EVIDENCE V.
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Affiliation(s)
- M P Reiman
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, NC, USA. .,Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark. .,Doctor of Physical Therapy Division, Department of Medicine, Duke University School of Medicine, DUMC 104002, Durham, NC, 27710, USA.
| | - K Thorborg
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.,Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), and Departments of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - K Covington
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, NC, USA
| | - C E Cook
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, NC, USA
| | - P Hölmich
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark.,Aspetar Sports Groin Pain Center, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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Kemp JL, Beasley I. 2016 international consensus on femoroacetabular impingement syndrome: the Warwick Agreement-why does it matter? Br J Sports Med 2017; 50:1162-3. [PMID: 27629402 DOI: 10.1136/bjsports-2016-096831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Joanne L Kemp
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Victoria, Australia Latrobe Sports Exercise Medicine Research Centre, La Trobe University, Australia
| | - Ian Beasley
- The Football Association, Medical Services, The Royal Ballet, London, UK
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35
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Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2017; 50:1169-76. [PMID: 27629403 DOI: 10.1136/bjsports-2016-096743] [Citation(s) in RCA: 595] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 12/29/2022]
Abstract
The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
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Affiliation(s)
- D R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E J Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - J O'Donnell
- Hip Arthroscopy Australia, Melbourne, Victoria, Australia St Vincents Private Hospital, East Melbourne, Victoria, Australia
| | - R Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - T Awan
- Medsport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - M Beck
- Department of Clinic of Orthopaedic and Trauma Surgery, Luzerner Kantonspital, Luzern, Switzerland
| | - J C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine St. Louis, St. Louis, Missouri, USA
| | - H P Dijkstra
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - E Falvey
- Sports Surgery Clinic, Dublin, Ireland Department of Medicine, University College Cork, Cork, Ireland
| | | | - R S Hinman
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Hölmich
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Orthopaedic Surgery, Sports Orthopaedic Research Center (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - A Kassarjian
- Corades, LLC, Brookline, Massachusetts, USA Medical Service, Madrid Open Tennis, Madrid, Spain
| | - H D Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - R Martin
- Rangos School of Health Sciences, Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - R C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - M J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - M P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - A Takla
- Hip Arthroscopy Australia, Melbourne, Victoria, Australia Australian Sports Physiotherapy Department of Physiotherapy, The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia Bond University
| | - K Thorborg
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - A Weir
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Centre for Evidence-based Sports Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - K L Bennell
- Department of Physiotherapy, The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia
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Wall PD, Dickenson EJ, Robinson D, Hughes I, Realpe A, Hobson R, Griffin DR, Foster NE. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med 2017; 50:1217-23. [PMID: 27629405 PMCID: PMC5036255 DOI: 10.1136/bjsports-2016-096368] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. METHODS In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. RESULTS The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. CONCLUSION PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). TRIAL REGISTRATION NUMBER ISRCTN 09754699.
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Affiliation(s)
- Peter Dh Wall
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Robinson
- Southbank Hospital Worcester, Spire Healthcare, Worcester, UK
| | - Ivor Hughes
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alba Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Damian R Griffin
- University Hospitals of Coventry and Warwickshire NHS Trust and Warwick Medical School, University of Warwick, Coventry, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences NIHR Professor of Musculoskeletal Health in Primary Care, Keele University, Keele, UK
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Spencer-Gardner L, Dissanayake R, Kalanie A, Singh P, O'Donnell J. Hip arthroscopy results in improved patient reported outcomes compared to non-operative management of waitlisted patients. J Hip Preserv Surg 2017. [PMID: 28630719 PMCID: PMC5467427 DOI: 10.1093/jhps/hnw051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hip arthroscopy (HA) is an established treatment option to address intra-articular pathology of the hip. However, some clinicians encourage non-operative management (NOM). Non-operative management may include active measures such as physiotherapy and intra-articular steroid injections, or NOM may involve so called watchful waiting with no active intervention. These approaches, along with surgery have been detailed recently in the Warwick Agreement, a Consensus Statement regarding diagnosis and treatment of Femoroacetabular Impingement Syndrome The aim of this study is to compare the change in clinical outcome scores of waitlisted patients with intra-articular hip pathology who receive no active treatment with matched controls that have undergone HA. Patients less than 60 years of age were identified from a HA waiting list in a single hospital in the Australian public hospital system. Patient reported outcomes (PRO) were collected whilst patients waited for surgery. During this waiting period no specific treatment was offered. A separate group of patients who had previously undergone HA were matched based on age, sex, body mass index and baseline non-arthritic hip scores (NAHS). The groups were compared using the NAHS as the primary outcome measures. Modified Harris Hip Scores were also collected and compared. Thirty-six patients were included in each group, with a mean follow up of 19 months (12–36). There were no significant differences in age, sex, BMI and NAHS between groups at baseline. At final follow up, mean NAHS scores after HA were significantly higher than scores after NOM, 82.1 (36.4–100.0) versus 48.9 (11.3–78.8), respectively (P < 0.001) with a large effect size for mean change in scores between groups (d = 1.77, 95% CI 1.21–2.30). Mean mHHS after HA were significantly higher than scores after NOM, 84.3 (15.4–100.0) versus 48.1 (21.0–66.0) respectively (P < 0.001), with a large effect size for mean change in scores between groups (d = 1.92, 95% CI 1.34–2.46). HA may lead to significant improvements in PRO when compared to non-operative management of waitlisted patients with intra-articular pathology of the hip at 18 months follow-up.
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Affiliation(s)
- Luke Spencer-Gardner
- The Hip Preservation Center, Baylor University Medical Center, 3900 Junius Street, #705, Dallas, TX 75246, USA
| | | | - Amir Kalanie
- St. Vincent's Private Hospital, Suite 901A St Vincent's Clinic 438 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Parminder Singh
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
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The Star Excursion Balance Test: Criterion and divergent validity on patients with femoral acetabular impingement. ACTA ACUST UNITED AC 2016; 26:104-109. [PMID: 27525357 DOI: 10.1016/j.math.2016.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/29/2016] [Accepted: 07/30/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND A valid functional test, evaluating dynamic balance control, might be valuable clinic tool for evaluation of treatment outcome on patients with femoral acetabular impingement (FAI). OBJECTIVES The aim of this study was to evaluate criterion and divergent validity of the Star Excursion Balance Test (SEBT) on patients with bilateral FAI- changes, with unilateral clinical symptoms. METHOD In this cross sectional correlational and comparative study fifteen patients with bilateral FAI with unilateral symptoms and 15 controls participated. Criterion validity was determined by analysing agreement between SEBT and The Copenhagen Hip and Groin Outcome Score (HAGOS), The Hip Sports Activity Scale (HSAS), pain and leg strength on FAI patients. Divergent validity was determined by comparing SEBT on FAI patients with controls and by comparing SEBT on patient's symptomatic and asymptomatic hips. RESULTS/FINDINGS SEBT posterolateral and posteromedial direction had high criterion validity in relation to HAGOS subscale pain intensity and symptoms (rs = 0.75, p = 0.001, respectively rs = 0.70, p = 0.004). Criterion validity was low in relation to HAGOS subscales sports, recreation, participation in physical activity and quality of life. SEBT in the posterolateral and posteromedial direction had good divergent validity (p = 0.006, respectively p = 0.001) and in the posterolateral direction SEBT could differentiate between patient's symptomatic and asymptomatic hip (p = 0.005). CONCLUSIONS SEBT in posterolateral and posteromedial direction has good criterion validity in relation to pain and other symptoms. In the posterolateral and posteromedial direction SEBT also had divergent validity. Clinically it is recommended to combine SEBT in the posterolateral and posteromedial direction with other measurements on patients with FAI.
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Griffin D, Dickenson E, Wall P, Realpe A, Adams A, Parsons N, Hobson R, Achten J, Costa M, Foster N, Hutchinson C, Petrou S, Donovan J. The feasibility of conducting a randomised controlled trial comparing arthroscopic hip surgery to conservative care for patients with femoroacetabular impingement syndrome: the FASHIoN feasibility study. J Hip Preserv Surg 2016; 3:304-311. [PMID: 29632690 PMCID: PMC5883184 DOI: 10.1093/jhps/hnw026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/24/2016] [Indexed: 11/13/2022] Open
Abstract
To determine whether it was feasible to perform a randomized controlled trial (RCT) comparing arthroscopic hip surgery to conservative care in patients with femoroacetabular impingement (FAI). This study had two phases: a pre-pilot and pilot RCT. In the pre-pilot, we conducted interviews with clinicians who treated FAI and with FAI patients to determine their views about an RCT. We developed protocols for operative and conservative care. In the pilot RCT, we determined the rates of patient eligibility, recruitment and retention, to investigate the feasibility of the protocol and we established methods to assess treatment fidelity. In the pre-pilot phase, 32 clinicians were interviewed, of which 26 reported theoretical equipoise, but in example scenarios 7 failed to show clinical equipoise. Eighteen patients treated for FAI were also interviewed, the majority of whom felt that surgery and conservative care were acceptable treatments. Surgery was viewed by patients as a 'definitive solution'. Patients were motivated to participate in research but were uncomfortable about randomization. Randomization was more acceptable if the alternative was available at the end of the trial. In the pilot phase, 151 patients were assessed for eligibility. Sixty were eligible and invited to take part in the pilot RCT; 42 consented to randomization. Follow-up was 100% at 12 months. Assessments of treatment fidelity were satisfactory. An RCT to compare arthroscopic hip surgery with conservative care in patients with FAI is challenging but feasible. Recruitment has started for a full RCT.
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Affiliation(s)
- D.R. Griffin
- Warwick Medical School, University of Warwick, Warwick, UK
| | - E.J. Dickenson
- Warwick Medical School, University of Warwick, Warwick, UK
| | - P.D.H. Wall
- Warwick Medical School, University of Warwick, Warwick, UK
| | - A. Realpe
- Warwick Medical School, University of Warwick, Warwick, UK
| | - A. Adams
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - N. Parsons
- Department of Statistics and Epidemiology, University of Warwick, Warwick, UK
| | - R. Hobson
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - J. Achten
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - M.L. Costa
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - N.E. Foster
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | | | - S. Petrou
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - J.L. Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes. Osteoarthritis Cartilage 2016; 24:1682-1696. [PMID: 27107630 DOI: 10.1016/j.joca.2016.04.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/21/2016] [Accepted: 04/13/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The optimal therapy for femoroacetabular impingement (FAI) is unclear. The aim of this systematic review was to examine the evidence for surgical and non-surgical treatment of FAI on symptom and structural outcomes. DESIGN MEDLINE and EMBASE were searched electronically. Surgical and non-surgical management strategies were searched with "FAI". Studies which included comparison groups and reported symptom or structural outcomes were included (Levels I-III evidence). A risk of bias assessment was performed. RESULTS Eighteen studies comparing management strategies for FAI were identified. Most studies had high risk of bias. No study compared surgical and non-surgical treatment. When surgical approaches were compared there was evidence of superior symptom outcomes with arthroscopy compared to open surgery and with labral preservation. There was some evidence that surgical interventions are effective in reducing alpha angle (improved hip shape), but no data on whether this affects long-term outcomes. There was some weak evidence that surgery is associated with structural progression of hip osteoarthritis (OA). CONCLUSIONS Although evidence supports improvement in symptoms after surgery in FAI, no studies have compared surgical and non-surgical treatment. Therefore no conclusion regarding the relative efficacy of one approach over the other can be made. Surgery improves alpha angle but whether this alters the risk of development or progression of hip OA is unknown. This review highlights the lack of evidence for use of surgery in FAI. Given that hip geometry may be modified by non-surgical factors, clarifying the role of non-surgical approaches vs surgery for the management of FAI is warranted.
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Heiderscheit B, McClinton S. Evaluation and Management of Hip and Pelvis Injuries. Phys Med Rehabil Clin N Am 2016; 27:1-29. [PMID: 26616175 DOI: 10.1016/j.pmr.2015.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Injuries to the hip and pelvis among runners can be among the most challenging to treat. Advances in the understanding of running biomechanics as it pertains to the lumbopelvic and hip regions have improved the management of these conditions. Conservative management with an emphasis on activity modification and neuromuscular exercises should comprise the initial plan of care, with injection therapies used in a supportive manner.
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Affiliation(s)
- Bryan Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1300 University Avenue, Madison, WI 53706, USA; UW Runners' Clinic, University of Wisconsin Health, 621 Science Dr, Madison, WI 53711, USA; Badger Athletic Performance Research, University of Wisconsin-Madison, 1440 Monroe St, Madison, WI 53711, USA.
| | - Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
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Liu Q, Wang W, Thoreson AR, Zhao C, Zhu W, Dou P. Finite element prediction of contact pressures in cam-type femoroacetabular impingement with varied alpha angles. Comput Methods Biomech Biomed Engin 2016; 20:294-301. [PMID: 27539713 DOI: 10.1080/10255842.2016.1224861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Three dimensional finite element models of cam-type FAI with alpha angles of 60°, 70°, 80°, and 90° were created to investigate the cartilage contact mechanics in daily activities. Intra-articular cartilage contact pressures during routine daily activities were assessed and cross-compared with a normal control hip. Alpha angles and hip range of motion were found to have a combined influence on the cartilage contact mechanics in hips with cam-type FAI, thereby resulting in abnormally high pressures and driving the cartilage damage. In particular, alpha angles of 80° or greater contribute to substantial pressure increase under certain types of daily activities.
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Affiliation(s)
- Qian Liu
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Wanchun Wang
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Andrew R Thoreson
- b Biomechanics Laboratory, Division of Orthopedic Research , Mayo Clinic , Rochester , MN , USA
| | - Chunfeng Zhao
- b Biomechanics Laboratory, Division of Orthopedic Research , Mayo Clinic , Rochester , MN , USA
| | - Weihong Zhu
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Pengcheng Dou
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
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Bennett AN, Nixon J, Roberts A, Barker-Davies R, Villar R, Houghton JM. Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population. BMJ Open Sport Exerc Med 2016; 2:e000144. [PMID: 27900190 PMCID: PMC5117082 DOI: 10.1136/bmjsem-2016-000144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 01/22/2023] Open
Abstract
Background Femoroacetabular impingement (FAI) is common with an estimated prevalence of 10–15% among young active individuals. The natural history of the disorder is progression to early osteoarthritis. Hip arthroscopy is recommended if conservative treatments fail; however, outcomes are unclear, particularly in highly active populations. Aim To evaluate the functional and vocational outcome of hip arthroscopy, as part of an evidence-based rehabilitation hip pain pathway, for the treatment of FAI in an active military population. Methods All patients in the defence rehabilitation hip pain pathway, with a confirmed diagnosis of FAI who failed conservative treatment, were assessed prior to surgery and at 2, 6 and 12 months postsurgery. Outcome measures included the Visual Analogue Scale (VAS) for hip pain, Non-Arthritic Hip Score (NAHS) for function, and vocational assessments including functional activity assessment (FAA) and Joint Medical Employment Standard for military employability and deployability. Results 101 patients completed the study (mean age=33 years) (male:female:75:26) (Royal Navy/British Army/Royal Air Force: 13%/48%/39%). Outcomes demonstrated significant improvements with large effect size. Preoperative NAHS mean=62.9 (SD 16.4), 12-month postoperative NAHS mean=78.8 (18.3), mean improvement in NAHS=15.9 (95% CI 12.3 to 19.5, p<0.001). Preoperative VAS pain mean=51.3 (20.9), 12-month postoperative VAS pain=25.6 (24.5). Mean improvement 25.7 (95% CI 19.4 to 31.99, p<0.001). 73% of patients had a deployable medical category at 12 months postoperative. Conclusions These data confirm that hip arthroscopy as part of a structured evidence-based multidisciplinary care pathway produces significant and continued symptomatic, functional and vocational improvements over a 12-month period in a military population exposed to high intensity, weight-bearing exercise in uncontrolled and unforgiving environments.
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Affiliation(s)
- A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - J Nixon
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - A Roberts
- Academic Department of Military Rehabilitation , Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - R Barker-Davies
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
| | - R Villar
- Department of Trauma and Orthopaedics , Wellington Hospital , London , UK
| | - J M Houghton
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre , Epsom, Surrey , UK
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Freke M, Kemp JL, Svege I, Risberg MA, Semciw AI, Crossley KM. Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence. Br J Sports Med 2016; 50:1180. [DOI: 10.1136/bjsports-2016-096152] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/23/2016] [Indexed: 01/16/2023]
Abstract
BackgroundFemoroacetabular impingement (FAI) and associated pathologies are associated with pain and reduced quality of life. Physical impairments can be associated with worse symptoms and may be an important target of rehabilitation programmes in this patient group. Knowledge regarding physical impairments in people with symptomatic FAI is limited.HypothesisIn adults aged 18–50 years with symptomatic FAI: (1) to identify physical impairments in range of motion (ROM), hip muscle function and functional tasks; (2) to compare physical impairments with healthy controls; and (3) to evaluate the effects of interventions targeting physical impairments.Study designSystematic review.MethodsA systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18–50 years with symptomatic FAI that examined ROM, hip muscle function and functional tasks were included. Standardised mean differences were calculated where possible or best evidence synthesis and study conclusions were presented.ResultsTwenty-two studies fulfilled all inclusion criteria. Methodological quality was varied. Results for hip joint ROM differences between people with symptomatic FAI compared and control subjects were varied. People with symptomatic FAI demonstrated some deficits in hip muscle strength and reduced balance on one leg when compared with control subjects. For hip joint ROM and hip muscle strength results for within-group differences between preintervention and postintervention time points were limited and inconclusive. No randomised controlled trials evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI.ConclusionsPeople with symptomatic FAI demonstrate impairments in some hip muscle strength and single leg balance. This information may assist therapists in providing targeted rehabilitation programmes for people with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance; and to evaluate whether targeted interventions are effective in symptomatic FAI.Clinical relevanceThis information may assist therapists in providing targeted rehabilitation programmes for people with symptomatic FAI.
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Abstract
Surgery for femoroacetabular impingement (FAI) has been advocated for correction of cam and pincer hip joint morphology. Surgery for FAI was first pioneered by Myers et al, who surgically treated FAI by open dislocation. Arthroscopy was then introduced in 2005 by Sampson. Arthroscopy has continued to develop since then, with the intent of providing pain relief and improving function in patients with FAI. This Viewpoint discusses the escalating popularity of FAI surgery, the widespread acceptance of this relatively new surgical procedure, and next steps for determination of who benefits from this treatment. J Orthop Sports Phys Ther 2016;46(6):406-408. doi:10.2519/jospt.2016.0605.
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Dickenson E, Wall PDH, Robinson B, Fernandez M, Parsons H, Buchbinder R, Griffin DR. Prevalence of cam hip shape morphology: a systematic review. Osteoarthritis Cartilage 2016; 24:949-61. [PMID: 26778530 DOI: 10.1016/j.joca.2015.12.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain. DESIGN All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous. RESULTS Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain. CONCLUSIONS There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain.
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Affiliation(s)
| | - P D H Wall
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - B Robinson
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - M Fernandez
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - H Parsons
- Warwick Medical School, United Kingdom.
| | - R Buchbinder
- Monash University Department of Clinical Epidemiology, Australia.
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Anderson LA, Anderson MB, Kapron A, Aoki SK, Erickson JA, Chrastil J, Grijalva R, Peters C. The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis. Clin Orthop Relat Res 2016; 474:342-52. [PMID: 26054483 PMCID: PMC4709310 DOI: 10.1007/s11999-015-4379-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is not known whether morphological abnormalities of the hip are compatible with lifelong hip function and avoidance of osteoarthritis (OA). Our purpose was to investigate the prevalence of radiographic findings consistent with femoroacetabular impingement (FAI) and dysplasia (DDH) in senior athletes with well-functioning hips. QUESTIONS/PURPOSES (1) What is the prevalence of FAI and DDH in senior athletes with well-functioning hips? (2) Are radiographic findings of FAI and DDH associated with OA? (3) Is a history of longer duration or more intense activity associated with hip pathomorphology? (4) Were the modified Harris hip scores and the Hip Outcome Scores lower (legacy scales) in patients with evidence of hip pathomorphology than those without? METHODS Five hundred forty-seven individuals (55% men, 45% women; 1081 hips, 534 bilateral and 13 unilateral), mean age 67 years (SD 8 years), gave consent and qualified for this institutional review board-approved cross-sectional study of senior athletes. Hips were independently evaluated for radiographic signs of FAI, DDH, and OA. Additionally, a lifetime activities questionnaire and outcome instruments were used to assess pain and function. Hips that had previously undergone arthroplasty or fracture surgery were excluded. RESULTS Eighty-three percent (898 of 1081) of hips had radiographic abnormalities consistent with FAI, of which 67% (599 of 898) were cam-type FAI. Ten percent (103 of 1081) of hips had radiographic evidence for dysplasia. Radiographic findings of FAI were not predictive of OA after controlling for age and sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.48-6.62; p = 0.390). Similarly, radiographic findings of DDH were not predictive of OA (OR, 1.48; 95% CI, 0.31-7.21; p = 0.62). Our data suggest an increased risk of FAI-type morphologies in athletes who participated in competitive sporting events during early adult years (OR, 1.49; 95% CI, 1.04-2.11; p = 0.020). Additionally, participants who reported lifetime participation in competitive sports were at an increased risk of OA compared with those who did not (OR, 1.75; 95% CI, 1.14-2.69; p = 0.007). There were no differences in outcome scores between athletes with and without morphologic abnormalities. CONCLUSIONS Radiographic findings consistent with FAI in these senior athletes were common and were not associated with the presence of OA. These data suggest that the need to screen for asymptomatic young athletes for radiographic evidence of FAI and DDH may not be necessary. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Lucas A. Anderson
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Mike B. Anderson
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Ashley Kapron
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Stephen K. Aoki
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Jill A. Erickson
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Jesse Chrastil
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Ramon Grijalva
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Christopher Peters
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
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Bowden A. Prelude to a Biological Phenotype for Osteoarthritis: Commentary on an article by Nobuaki Chinzei, MD, PhD, et al.: "Inflammation and Degeneration in Cartilage Samples from Patients with Femoroacetabular Impingement". J Bone Joint Surg Am 2016; 98:e10. [PMID: 26791038 DOI: 10.2106/jbjs.o.01064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Lee CB. Surgical innovation and safety: femoroacetabular impingement and the IDEAL collaborative framework. J Hip Preserv Surg 2015; 3:89-96. [PMID: 27583143 PMCID: PMC5005043 DOI: 10.1093/jhps/hnv074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/25/2015] [Indexed: 11/23/2022] Open
Abstract
Operative treatment of femoroacetabular impingement (FAI) is a relatively new, yet rapidly expanding surgical innovation. Although the practice of surgery is inherently innovative, there is no clear distinction between minor technical variation and true modification that warrants testing. This raises important questions about how new procedures should be evaluated before being broadly disseminated. The IDEAL Collaborative is a consortium that promotes safe and responsible translation of research into clinical practice. The collaborative has delineated the typical stages of evolution of new interventional technologies, and the type of study designs appropriate for each stage. This report examines the surgical treatment of FAI as a case study of the IDEAL framework and discusses both missed and future opportunities for critical assessment.
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Affiliation(s)
- Cara Beth Lee
- Center for Hip Preservation, Virginia Mason Medical Center, 925 Seneca Street, Lindeman Pavilion, Level 6, Seattle, WA 98111, USA
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Falvey ÉC, King E, Kinsella S, Franklyn-Miller A. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients--clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med 2015; 50:423-30. [PMID: 26626272 PMCID: PMC4819645 DOI: 10.1136/bjsports-2015-094912] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
Background Athletic groin pain remains a common field-based team sports time-loss injury. There are few reports of non-surgically managed cohorts with athletic groin pain. Aim To describe clinical presentation/examination, MRI findings and patient-reported outcome (PRO) scores for an athletic groin pain cohort. Methods All patients had a history including demographics, injury duration, sport played and standardised clinical examination. All patients underwent MRI and PRO score to assess recovery. A clinical diagnosis of the injured anatomical structure was made based on these findings. Statistical assessment of the reliability of accepted standard investigations undertaken in making an anatomical diagnosis was performed. Result 382 consecutive athletic groin pain patients, all male, enrolled. Median time in pain at presentation was (IQR) 36 (16–75) weeks. Most (91%) played field-based ball-sports. Injury to the pubic aponeurosis (PA) 240 (62.8%) was the most common diagnosis. This was followed by injuries to the hip in 81 (21.2%) and adductors in 56 (14.7%) cases. The adductor squeeze test (90° hip flexion) was sensitive (85.4%) but not specific for the pubic aponeurosis and adductor pathology (negative likelihood ratio 1.95). Analysed in series, positive MRI findings and tenderness of the pubic aponeurosis had a 92.8% post-test probability. Conclusions In this largest cohort of patients with athletic groin pain combining clinical and MRI diagnostics there was a 63% prevalence of PA injury. The adductor squeeze test was sensitive for athletic groin pain, but not specific individual pathologies. MRI improved diagnostic post-test probability. No hernia or incipient hernia was diagnosed. Clinical trial registration number NCT02437942.
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Affiliation(s)
- É C Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland Department of Medicine, University College Cork, Cork, Ireland
| | - E King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland Department of Life Sciences, Roehampton University Dublin, London, UK
| | - S Kinsella
- Department of Medicine, University College Cork, Cork, Ireland
| | - A Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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