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Kelly M, Secomb J. Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary. Int J Sports Phys Ther 2024; 19:625-641. [PMID: 38707850 PMCID: PMC11065768 DOI: 10.26603/001c.116580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/29/2024] [Indexed: 05/07/2024] Open
Abstract
Femoroacetabular impingement (FAI), particularly cam morphology, is highly prevalent among elite hockey athletes. Moreover, hip and groin pain has become a common issue in hockey, with approximately 50% of European professional athletes reported to experience a hip or groin problem during a season. While most athletes will not miss training or competition due to this, restricted competitive performance and increased risk of reduced physical and psychological well-being are likely. Recent research suggests that the development of cam morphology is related to the repetitive shear stresses experienced at the hip joint during adolescence from skating. This condition likely increases the potential for intra-articular and extra-articular injuries in these athletes later in their careers. Research also indicates that the hip joint mechanics during forward skating substantially increase the possibility of sustaining a labral tear compared to other sports. Such an injury can increase femoral head movement within the joint, potentially causing secondary damage to the iliofemoral ligament, ligamentum teres and joint capsule. These injuries and the high density of nociceptors in the affected structures may explain the high prevalence of hip and groin pain in hockey athletes. Compensatory adaptations, such as reduced hip strength, stability, and range-of-motion (ROM) likely increase the opportunity for core muscle injuries and hip flexor and adductor injuries. Specifically, the limited hip ROM associated with cam morphology appears to exacerbate the risk of these injuries as there will be an increase in pubic symphysis stress and transverse strain during rotational movements. It is hoped that this article will assist practitioners currently working with hockey athletes to develop evidence-informed monitoring strategies and training interventions, aimed at reducing the incidence and severity of hip and groin problems, ultimately enhancing athlete performance and well-being. Therefore, the purpose of this clinical commentary was to examine current evidence on common hip pathologies in hockey athletes, exploring potential associations between hip and groin pain and the biomechanics of hockey activities. Level of Evidence 5.
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Affiliation(s)
- Matt Kelly
- Physiotherapy and BiomechanicsSport Science Rehab and Performance Centre
| | - Josh Secomb
- Applied Sports Science and Exercise Testing LaboratoryUniversity of Newcastle Australia
- Active Living Research ProgramHunter Medical Research Institute
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2
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Loewen AM, Morris WZ, Ulman S, Tulchin-Francis K, Sucato DJ, Podeszwa DA, Ellis HB. Pre-operative gait kinematics and kinetics do not change following surgery in adolescent patients with femoroacetabular impingement. Gait Posture 2024; 109:213-219. [PMID: 38359697 DOI: 10.1016/j.gaitpost.2024.02.006] [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: 03/01/2023] [Revised: 12/21/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a condition where the femoral head-neck junction collides with the acetabulum. Open or arthroscopic treatment of FAI aims to increase hip motion while reducing impingement during passive or dynamic movements. RESEARCH QUESTION What are the biomechanical characteristics of the hip and pelvis in adolescents and young adults diagnosed with FAI syndrome 1) pre-operatively compared to controls and 2) pre- to post-operatively? METHODS 43 patients with FAI and 43 controls were included in the study. All patients with FAI had cam deformities and underwent unilateral hip preservation surgery (either open or arthroscopic). Pre- and post-operative imaging, patient-reported outcomes, and gait analysis were performed. Joint angles and internal joint moments were evaluated with an emphasis on the pelvis and hip. A comparative analysis was conducted to evaluate the gait patterns before and after surgical treatment, as well as to compare pre-operative gait patterns to a control group. RESULTS 43 patients with FAI (28 female, 16.5 ± 1.5 yrs) and 43 controls (28 female, 16.0 ± 1.5 yrs) were included. Pre-operative patients with FAI had decreased stride length and walking speed compared to controls, with no significant change following surgery. There were no differences in sagittal and coronal plane hip and pelvis kinematics comparing pre- to post-operative and pre-operative to controls. Pre-operatively, differences in internal hip rotation angle (pre: 3.3˚, post: 3.9˚, controls: 7.7˚) and hip extensor moment (pre: 0.121, post: 0.090, controls: 0.334 Nm/kg) were observed compared to controls with no significant changes observed following surgery. SIGNIFICANCE Compensatory movement strategies in pelvic and hip motion are evident during gait in patients with FAI, particularly in the sagittal and transverse planes. These strategies remained consistent two years post-surgery. While surgery improved radiographic measures and patient-reported outcomes, gait did not elicit biomechanical changes following surgical treatment.
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Affiliation(s)
| | - William Z Morris
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sophia Ulman
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Dan J Sucato
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A Podeszwa
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
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3
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Lerch TD, Huber FA, Bredella MA, Steppacher SD, Tannast M, Vicentini JRT, Torriani M. MRI 3D simulation of hip motion in female patients with and without ischiofemoral impingement. Skeletal Radiol 2024; 53:67-73. [PMID: 37269382 DOI: 10.1007/s00256-023-04376-7] [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: 04/11/2023] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To utilize hip MRI 3D models for demonstration of location and frequency of impingement during simulated range-of-motion in ischiofemoral impingement (IFI) compared to non-IFI hips. MATERIALS AND METHODS Sixteen hips (N = 7 IFI, 9 non-IFI) from 8 females were examined with high-resolution MRI. We performed image segmentation and generated 3D bone models and simulated hip range-of-motion and impingement. We examined the frequency and location of bone contact in early external rotation and early extension (0-20°), isolated maximum external rotation, and isolated maximum extension. Frequency and location of impingement at varied combinations of external rotation and extension and areas of simulated bone impingement at early external rotation and extension were compared between IFI and non-IFI. RESULTS Higher frequency of bony impingement occurred more often in IFI hips at each simulated range-of-motion combination (P < 0.05). Impingement involved the lesser trochanter more often in IFI hips (P < 0.001) and occurred at early degrees of external rotation and extension. In isolated maximum external rotation, only the greater trochanter, intertrochanteric area, or both combined were involved, in 14%, 57%, and 29% in IFI hips. In isolated maximum extension, the lesser trochanter, intertrochanteric area, or both combined were involved in 71%, 14%, and 14% in IFI hips. The simulated area of bone impingement was significantly higher in IFI hips (P = 0.02). CONCLUSION Hip MRI 3D models are feasible for simulated range-of-motion and show a higher frequency of extra-articular impingement at early stages of external rotation and extension in IFI compared to non-IFI hips.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Florian A Huber
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Simon D Steppacher
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Moritz Tannast
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Joao R T Vicentini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
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Boschung A, Antioco T, Steppacher SD, Tannast M, Novais EN, Kim YJ, Lerch TD. Posterior Hip Impingement at Maximal Hip Extension in Female Patients With Increased Femoral Version or Increased McKibbin Index and Its Effect on Sports Performance. Orthop J Sports Med 2023; 11:23259671231184802. [PMID: 37529532 PMCID: PMC10387700 DOI: 10.1177/23259671231184802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 08/03/2023] Open
Abstract
Background The location of posterior hip impingement at maximal extension in patients with posterior femoroacetabular impingement (FAI) is unclear. Purpose To investigate the frequency and area of impingement at maximal hip extension and at 10° and 20° of extension in female patients with increased femoral version (FV) and posterior hip pain. Study Design Cross-sectional study; Level of evidence, 3. Methods Osseous patient-specific 3-dimensional (3D) models were generated of 50 hips (37 female patients, 3D computed tomography) with a positive posterior impingement test and increased FV (defined as >35°). The McKibbin index (combined version) was calculated as the sum of FV and acetabular version (AV). Subgroups of patients with an increased McKibbin index >70° (24 hips) and FV >50° (20 hips) were analyzed. A control group of female participants (10 hips) had normal FV, normal AV, and no valgus deformity (neck-shaft angle, <139°). Validated 3D collision detection software was used for simulation of osseous impingement-free hip extension (no rotation). Results The mean impingement-free maximal hip extension was significantly lower in patients with FV >35° compared with the control group (15° ± 15° vs 55° ± 19°; P < .001). At maximal hip extension, 78% of patients with FV >35° had osseous posterior extra-articular ischiofemoral hip impingement. At 20° of extension, the frequency of posterior extra-articular ischiofemoral impingement was significantly higher for patients with a McKibbin index >70° (83%) and for patients with FV >35° (76%) than for controls (0%) (P < .001 for both). There was a significant correlation between maximal extension (no rotation) and FV (r = 0.46; P < .001) as well as between impingement area at 20° of extension (external rotation [ER], 0°) and McKibbin index (0.61; P < .001). Impingement area at 20° of extension (ER, 0°) was significantly larger for patients with McKibbin index >70° versus <70° (251 vs 44 mm2; P = .001). Conclusion The limited hip extension found in our study could theoretically affect the performance of sports activities such as running, ballet dancing, or lunges. Therefore, although not examined directly in this study, these activities are not advisable for these patients. Preoperative evaluation of FV and the McKibbin index is important in female patients with posterior hip pain before hip preservation surgery (eg, hip arthroscopy).
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Affiliation(s)
- Adam Boschung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon D. Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Eduardo N. Novais
- Department of Pediatric Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-jo Kim
- Department of Pediatric Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Pediatric Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Cannon J, Rankin JW, Lewton KL, Liu J, Powers CM. Femoral and acetabular features explain acetabular contact pressure sensitivity to hip internal rotation in persons with cam morphology: A finite element analysis. Clin Biomech (Bristol, Avon) 2023; 107:106025. [PMID: 37302302 DOI: 10.1016/j.clinbiomech.2023.106025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Femoroacetabular impingement is characterized by premature contact between the proximal femur and acetabulum. The loss of femoral head-neck concavity associated with cam morphology leads to mechanical impingement during hip flexion and internal rotation. Other femoral and acetabular features have been linked with mechanical impingement but have not been comprehensively investigated. This study sought to determine which bony features are most influential in contributing to mechanical impingement in persons with a cam morphology. METHODS Twenty individuals (10 female, 10 male) with a cam morphology participated. Finite element analyses incorporating subject-specific bony geometry derived from computed tomography scans were used to determine which femoral (alpha angle and femoral neck-shaft angle) and acetabular (anteversion angle, inclination angle, depth, and lateral center-edge angle) features accentuate acetabular contact pressure with increasing degrees of hip internal rotation with the hip flexed to 90°. To determine the best predictors of acetabular contact pressure sensitivity to internal rotation, all morphological variables were included in a stepwise regression with the final model subjected to a bootstrapping procedure. FINDINGS The stepwise regression revealed that femoral neck-shaft angle, acetabular anteversion angle, acetabular inclination angle, and acetabular depth were the best combination of variables to predict contact pressure sensitivity to internal rotation, explaining 55% of the variance. Results of the bootstrap analysis revealed that a median value of 65% [37%, 89%] variance in sensitivity could be explained by these morphological variables. INTERPRETATION Mechanical impingement and the concomitant acetabular contact pressure are modulated by multiple femoral and acetabular features in persons with a cam morphology.
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Affiliation(s)
- Jordan Cannon
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffery W Rankin
- Rancho Research Institute, Rehabilitation Engineering Program, Downey, CA, USA
| | - Kristi L Lewton
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jia Liu
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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Feingold JD, Srikumar S, Vaswani R, White AE, Swartwout EL, Ranawat AS. The Outcome of Hip Arthroscopy in the Setting of Lumbar Spine Disease Is Beneficial, Yet Limited: A Systematic Review of Existing Evidence. Arthroscopy 2023; 39:1568-1583. [PMID: 36191731 DOI: 10.1016/j.arthro.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/04/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To compare hip arthroscopy outcomes in femoroacetabular impingement (FAI) patients with concurrent symptomatic lumbar spine disease to the outcomes of arthroscopic FAI patients without spine disease. METHODS A systematic review was performed according to PRISMA guidelines via PubMed, Cochrane, Embase, and Google Scholar databases. Studies were valid for inclusion if they had an average follow-up ≥12 months and compared patient-reported outcome measures (PROMs) in hip arthroscopy patients with and without concurrent spinal disease. Data collected included study characteristics, patient demographics, follow-up intervals, surgical indications, spinal pathology, PROMs, and reoperation rates. RESULTS Twelve studies were included in this systematic review. 3,107 patients who underwent hip arthroscopy were evaluated: 1,056 with coexisting lumbar spine disease (spine cohort) and 2,051 control subjects without spine disease (control cohort). The average follow-up period was 24 months. Across included studies, there were 35 instances wherein postoperative PROM scores reported by each cohort were compared. In all 35 instances, the spine cohort reported inferior postoperative PROM scores with the difference being significant (P < .05) on 23 PROMs. Collectively, 23 cases were available contrasting the proportion of each cohort to achieve the minimal clinically important difference (MCID). In 22 (95.65%) of these cases, the spine cohort achieved the MCID at a lower rate than the control cohort. There were 14 PROMs, wherein intragroup analyses were reported that compared the preoperative and postoperative score reported by the spine cohort. On all 14 PROMs, the spine cohort reported significant (P < .05) improvement after arthroscopic intervention. CONCLUSION FAI patients with coexisting lumbar spine pathology experience significant improvement from baseline state after arthroscopic intervention. However, the postoperative outcomes reported are inferior, and the improvement from arthroscopy was limited when compared to surgical control subjects with FAI and normal spinal anatomy. LEVEL OF EVIDENCE Level IV: systematic review of Level II, III, and IV studies.
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Affiliation(s)
| | | | - Ravi Vaswani
- Hospital for Special Surgery, New York, New York, USA
| | - Alex E White
- Hospital for Special Surgery, New York, New York, USA
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Paton BM, Read P, van Dyk N, Wilson MG, Pollock N, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Stirling B, Tulloch L, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med 2023; 57:278-291. [PMID: 36650032 DOI: 10.1136/bjsports-2021-105384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,British Athletics, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers Football Club, Blackburn, UK
| | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Murphy
- Medical Services, Arsenal Football Club, London, UK
| | - Ricci Plastow
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK.,Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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Boschung A, Antioco T, Steppacher SD, Tannast M, Novais EN, Kim YJ, Lerch TD. Limited External Rotation and Hip Extension Due to Posterior Extra-articular Ischiofemoral Hip Impingement in Female Patients With Increased Femoral Anteversion: Implications for Sports, Sexual, and Daily Activities. Am J Sports Med 2023; 51:1015-1023. [PMID: 36812494 DOI: 10.1177/03635465231153624] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Posterior femoroacetabular impingement (FAI) is poorly understood. Patients with increased femoral anteversion (FV) exhibit posterior hip pain. PURPOSE To correlate hip impingement area with FV and with combined version and to investigate frequency of limited external rotation (ER) and hip extension (<40°, <20°, and <0°) due to posterior extra-articular ischiofemoral impingement. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Osseous patient-specific three-dimensional (3D) models based on 3D computed tomography scans were generated of 37 female patients (50 hips) with positive posterior impingement test (100%) and increased FV >35° (Murphy method). Surgery was performed in 50% of patients (mean age, 30 years; 100% female). FV and acetabular version (AV) were added to calculate combined version. Subgroups of patients (24 hips) with increased combined version >70° and patients (9 valgus hips) with increased combined version >50° were analyzed. The control group (20 hips) had normal FV, normal AV, and no valgus. Bone segmentation was performed to generate 3D models of every patient. Validated 3D collision detection software was used for simulation of impingement-free hip motion (equidistant method). Impingement area was evaluated in combined 20° of ER and 20° of extension. RESULTS Posterior extra-articular ischiofemoral impingement occurred between the ischium and the lesser trochanter in 92% of patients with FV >35° in combined 20° of ER and 20° of extension. Impingement area in combined 20° of ER and 20° of extension was larger with increasing FV and with higher combined version; correlation was significant (P < .001, r = 0.57, and r = 0.65). Impingement area was significantly (P = .001) larger (681 vs 296 mm2) for patients with combined version >70° (vs <70°, respectively) in combined 20° of ER and 20° of extension. All symptomatic patients with increased FV >35° (100%) had limited ER <40°, and most (88%) had limited extension <40°. The frequency of posterior intra- and extra-articular hip impingement of symptomatic patients (100% and 88%, respectively) was significantly (P < .001) higher compared with the control group (10% and 10%, respectively). The frequency of patients with increased FV >35° with limited extension <20° (70%) and patients with limited ER <20° (54%) was significantly (P < .001) higher compared with the control group (0% and 0%, respectively). The frequency of completely limited extension <0° (no extension) and ER <0° (no ER in extension) was significantly (P < .001) higher for valgus hips (44%) with combined version >50° compared with patients with FV >35° (0%). CONCLUSION All patients with increased FV >35° had limited ER <40°, and most of them had limited extension <20° due to posterior intra- or extra-articular hip impingement. This is important for patient counselling, for physical therapy, and for planning of hip-preservation surgery (eg, hip arthroscopy). This finding has implications and could limit daily activities (long-stride walking), sexual activity, ballet dancing, and sports (eg, yoga or skiing), although not studied directly. Good correlation between impingement area and combined version supports evaluation of combined version in female patients with positive posterior impingement test or posterior hip pain.
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Affiliation(s)
- Adam Boschung
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Eduardo N Novais
- Childrens Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-Jo Kim
- Childrens Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Till Dominic Lerch
- Childrens Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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9
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Boschung A, Antioco T, Novais EN, Kim YJ, Kiapour A, Tannast M, Steppacher SD, Lerch TD. Large Hip Impingement Area and Subspine Hip Impingement in Patients With Absolute Femoral Retroversion or Decreased Combined Version. Orthop J Sports Med 2023; 11:23259671221148502. [PMID: 36846812 PMCID: PMC9950619 DOI: 10.1177/23259671221148502] [Citation(s) in RCA: 3] [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] [Received: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 02/25/2023] Open
Abstract
Background It remains unclear if femoral retroversion is a contraindication for hip arthroscopy in patients with femoroacetabular impingement (FAI). Purpose To compare the area and location of hip impingement at maximal flexion and during the FADIR test (flexion, adduction, internal rotation) in FAI hips with femoral retroversion, hips with decreased combined version, and asymptomatic controls. Study Design Cross-sectional study; Level of evidence, 3. Methods Twenty-four symptomatic patients (37 hips) with anterior FAI were evaluated. All patients had femoral version (FV) <5° according to the Murphy method. Two subgroups were analyzed: 13 hips with absolute femoral retroversion (FV <0°) and 29 hips with decreased combined version (McKibbin index <20°). All patients were symptomatic and had anterior groin pain and a positive anterior impingement test ; all had undergone pelvic computed tomography (CT) scans to measure FV. The asymptomatic control group consisted of 26 hips. Dynamic impingement simulation of maximal flexion and FADIR test at 90° of flexion was performed with patient-specific CT-based 3-dimensional models. Extra- or intra-articular hip impingement area and location were compared between the subgroups and with control hips using nonparametric tests. Results Impingement area was significantly larger for hips with decreased combined version (<20°) versus combined version (≥20°) (mean ± SD; 171 ± 140 vs 78 ± 55 mm2; P = .012) and was significantly larger for hips with FV <0° (absolute femoral retroversion) vs FV >0° (P = .025). Hips with absolute femoral retroversion had a significantly higher frequency of extra-articular subspine impingement versus controls (92% vs 0%; P < .001), compared to 84% of patients with decreased combined version. Intra-articular femoral impingement location was most often (95%) anterosuperior and anterior (2-3 o'clock). Anteroinferior femoral impingement location was significantly different at maximal flexion (anteroinferior [4-5 o'clock]) versus the FADIR test (anterosuperior and anterior [2-3 o'clock]) (P < .001). Conclusion Patients with absolute femoral retroversion (FV <0°) had a larger hip impingement area, and most exhibited extra-articular subspine impingement. Preoperative FV assessment with advanced imaging (CT/magnetic resonance imaging) could help to identify these patients (without 3-dimensional modeling). Femoral impingement was located anteroinferiorly at maximal flexion and anterosuperiorly and anteriorly during the FADIR test.
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Affiliation(s)
- Adam Boschung
- Department of Diagnostic, Interventional and Pediatric Radiology,
Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Orthopedic Surgery and Traumatology, Fribourg Cantonal
Hospital, University of Fribourg, Fribourg, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Pediatric Radiology,
Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Eduardo N. Novais
- Department of Pediatric Orthopedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-jo Kim
- Department of Pediatric Orthopedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata Kiapour
- Department of Pediatric Orthopedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Moritz Tannast
- Department of Orthopedic Surgery and Traumatology, Fribourg Cantonal
Hospital, University of Fribourg, Fribourg, Switzerland
| | - Simon D. Steppacher
- Department of Orthopedic Surgery, Inselspital, University Hospital
Bern, University of Bern, Switzerland
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology,
Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Pediatric Orthopedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Till D. Lerch, MD, PhD, Department of Diagnostic, Interventional
and Pediatric Radiology, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland
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10
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Boschung A, Faulhaber S, Kiapour A, Kim YJ, Novais EN, Steppacher SD, Tannast M, Lerch TD. Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion : implications for hip arthroscopy. Bone Joint Res 2023; 12:22-32. [PMID: 36620909 PMCID: PMC9872041 DOI: 10.1302/2046-3758.121.bjr-2022-0263.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in FAI patients. METHODS A retrospective study involving 24 patients (37 hips) with FAI and femoral retroversion (femoral version (FV) < 5° per Murphy method) was performed. All patients were symptomatic (mean age 28 years (SD 9)) and had anterior hip/groin pain and a positive anterior impingement test. Cam- and pincer-type subgroups were analyzed. Patients were compared to an asymptomatic control group (26 hips). All patients underwent pelvic CT scans to generate personalized CT-based 3D models and validated software for patient-specific impingement simulation (equidistant method). RESULTS Mean impingement-free flexion of patients with mixed-type FAI (110° (SD 8°)) and patients with pincer-type FAI (112° (SD 8°)) was significantly (p < 0.001) lower compared to the control group (125° (SD 13°)). The frequency of extra-articular subspine impingement was significantly (p < 0.001) increased in patients with pincer-type FAI (57%) compared to cam-type FAI (22%) in 125° flexion. Bony impingement in maximal flexion was located anterior-inferior at femoral four and five o'clock position in patients with cam-type FAI (63% (10 of 16 hips) and 37% (6 of 10 hips)), and did not involve the cam deformity. The cam deformity did not cause impingement in maximal flexion. CONCLUSION Femoral impingement in maximal flexion was located anterior-inferior distal to the cam deformity. This differs to previous studies, a finding which could be important for FAI patients in order to avoid exacerbation of hip pain in deep flexion (e.g. during squats) and for hip arthroscopy (hip-preservation surgery) for planning of bone resection. Hip impingement in flexion has implications for daily activities (e.g. putting on shoes), sports, and sex.Cite this article: Bone Joint Res 2023;12(1):22-32.
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Affiliation(s)
- Adam Boschung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Senta Faulhaber
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ata Kiapour
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-jo Kim
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduardo N. Novais
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon D. Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland,Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA, Till D. Lerch. E-mail:
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11
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Lerch TD, Kim YJ, Kiapour A, Zwingelstein S, Steppacher SD, Tannast M, Siebenrock KA, Novais EN. Limited Hip Flexion and Internal Rotation Resulting From Early Hip Impingement Conflict on Anterior Metaphysis of Patients With Untreated Severe SCFE Using 3D Modelling. J Pediatr Orthop 2022; 42:e963-e970. [PMID: 36099440 PMCID: PMC7614193 DOI: 10.1097/bpo.0000000000002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescent patients that can result in complex 3 dimensional (3D)-deformity and hip preservation surgery (eg, in situ pinning or proximal femoral osteotomy) is often performed. But there is little information about location of impingement.Purpose/Questions: The purpose of this study was to evaluate (1) impingement-free hip flexion and internal rotation (IR), (2) frequency of impingement in early flexion (30 to 60 degrees), and (3) location of acetabular and femoral impingement in IR in 90 degrees of flexion (IRF-90 degrees) and in maximal flexion for patients with untreated severe SCFE using preoperative 3D-computed tomography (CT) for impingement simulation. METHODS A retrospective study involving 3D-CT scans of 18 patients (21 hips) with untreated severe SCFE (slip angle>60 degrees) was performed. Preoperative CT scans were used for bone segmentation of preoperative patient-specific 3D models. Three patients (15%) had bilateral SCFE. Mean age was 13±2 (10 to 16) years and 67% were male patients (86% unstable slip, 81% chronic slip). The contralateral hips of 15 patients with unilateral SCFE were evaluated (control group). Validated software was used for 3D impingement simulation (equidistant method). RESULTS (1) Impingement-free flexion (46±32 degrees) and IRF-90 degrees (-17±18 degrees) were significantly ( P <0.001) decreased in untreated severe SCFE patients compared with contralateral side (122±9 and 36±11 degrees).(2) Frequency of impingement was significantly ( P <0.001) higher in 30 and 60 degrees flexion (48% and 71%) of patients with severe SCFE compared with control group (0%).(3) Acetabular impingement conflict was located anterior-superior (SCFE patients), mostly 12 o'clock (50%) in IRF-90 degrees (70% on 2 o'clock for maximal flexion). Femoral impingement was located on anterior-superior to anterior-inferior femoral metaphysis (between 2 and 6 o'clock, 40% on 3 o'clock and 40% on 5 o'clock) in IRF-90 degrees and on anterior metaphysis (40% on 3 o'clock) in maximal flexion and frequency was significantly ( P <0.001) different compared with control group. CONCLUSION Severe SCFE patients have limited hip flexion and IR due to early hip impingement using patient-specific preoperative 3D models. Because of the large variety of hip motion, individual evaluation is recommended to plan the osseous correction for severe SCFE patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Till D. Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Orthopedic surgery, Child and Young Adult Hip Preservation Program at Boston Children’s Hospital, Boston, MA, USA
| | - Young-Jo Kim
- Department of Orthopedic surgery, Child and Young Adult Hip Preservation Program at Boston Children’s Hospital, Boston, MA, USA
| | - Ata Kiapour
- Department of Orthopedic surgery, Child and Young Adult Hip Preservation Program at Boston Children’s Hospital, Boston, MA, USA
| | - Sébastien Zwingelstein
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon D. Steppacher
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A. Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Eduardo N. Novais
- Department of Orthopedic surgery, Child and Young Adult Hip Preservation Program at Boston Children’s Hospital, Boston, MA, USA
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12
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Lerch TD, Antioco T, Boschung A, Meier MK, Schmaranzer F, Novais EN, Tannast M, Steppacher SD. Hip Impingement Location in Maximal Hip Flexion in Patients With Femoroacetabular Impingement With and Without Femoral Retroversion. Am J Sports Med 2022; 50:2989-2997. [PMID: 36037094 DOI: 10.1177/03635465221110887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Symptomatic patients with femoroacetabular impingement (FAI) have limitations in daily activities and sports and report the exacerbation of hip pain in deep flexion. Yet, the exact impingement location in deep flexion and the effect of femoral version (FV) are unclear. PURPOSE To investigate the acetabular and femoral locations of intra- or extra-articular hip impingement in flexion in patients with FAI with and without femoral retroversion. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS An institutional review board-approved retrospective study involving 84 hips (68 participants) was performed. Of these, symptomatic patients (37 hips) with anterior FAI and femoral retroversion (FV <5°) were compared with symptomatic patients (21 hips) with anterior FAI (normal FV) and with a control group (26 asymptomatic hips without FAI and normal FV). All patients were symptomatic, had anterior hip pain, and had positive anterior impingement test findings. Most of the patients had hip/groin pain in maximal flexion or deep flexion or during sports. All 84 hips underwent pelvic computed tomography (CT) to measure FV as well as validated dynamic impingement simulation with patient-specific CT-based 3-dimensional models using the equidistant method. RESULTS In maximal hip flexion, femoral impingement was located anterior-inferior at 4 o'clock (57%) and 5 o'clock (32%) in patients with femoral retroversion and mostly at 5 o'clock in patients without femoral retroversion (69%) and in asymptomatic controls (76%). Acetabular intra-articular impingement was located anterior-superior (2 o'clock) in all 3 groups. In 125° of flexion, patients with femoral retroversion had a significantly (P < .001) higher prevalence of anterior extra-articular subspine impingement (54%) and anterior intra-articular impingement (89%) compared with the control group (29% and 62%, respectively). CONCLUSION Knowing the exact location of hip impingement in deep flexion has implications for surgical treatment, sports, and physical therapy and confirms previous recommendations: Deep flexion (eg, during squats/lunges) should be avoided in patients with FAI and even more in patients with femoral retroversion. Patients with femoral retroversion may benefit and have less pain when avoiding deep flexion. For these patients, the femoral location of the impingement conflict in flexion was different (anterior-inferior) and distal to the cam deformity compared with the location during the anterior impingement test (anterior-superior). This could be important for preoperative planning and bone resection (cam resection or acetabular rim trimming) during hip arthroscopy or open hip preservation surgery to ensure that the region of impingement is appropriately identified before treatment.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eduardo N Novais
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Moritz Tannast
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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13
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Kannan AS, Hartwell MJ, Grace T, Hammond E, Soriano KKJ, Souza RB, Zhang AL. Correlating Biomechanical Gait Analysis With Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Orthop J Sports Med 2022; 10:23259671221121352. [PMID: 36089924 PMCID: PMC9449515 DOI: 10.1177/23259671221121352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Postoperative biomechanics after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are an outcome of interest, but correlation with patient-reported outcomes (PROs) remains unclear. Purpose/Hypothesis The purpose of this study was to assess the correlation between changes in hip biomechanics in FAIS patients after hip arthroscopy and changes in PRO scores. We hypothesized that gait analysis would demonstrate significant correlations between pre- and postoperative changes in biomechanics and changes in PRO scores. Study Design Descriptive laboratory study. Methods FAIS patients without dysplasia or arthritis who underwent primary hip arthroscopy for labral repair and femoroplasty underwent preoperative and 1-year postoperative 3-dimensional motion tracking and biomechanical testing during normal gait. Joint kinematics calculated included flexion/extension (sagittal plane), abduction/adduction (frontal plane), and internal/external rotation (transverse plane). Peak hip angles and moments were compared between baseline and 1-year postoperative measures. At baseline, 1-year, and 2-year postoperatively, patients completed the following PRO surveys: 12-Item Short Form Health Survey (SF-12), modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Joint kinematics that significantly improved 1 year after surgery were assessed for correlations with PRO scores. Results A total of 10 patients (12 hips) were enrolled prospectively. PROs significantly improved at 1 and 2 years postoperatively compared with baseline values for HOOS, mHHS, and SF-12 Physical Component Score, with all patients achieving the minimal clinically important difference (MCID) on the HOOS Sport/Recreation and Quality of Life subscales. From preoperatively to 1-year postoperatively, significant improvements were seen in peak hip abduction angle (from -2.3° ± 1.8° to -4.6° ± 1.8°; P = .0058) and peak hip extension moment (from -1.03 ± 0.19 to -0.85 ± 0.20 N·m/kg; P = .014); however, there were no significant correlations between these changes and the pre- to postoperative changes on any PRO scores. Conclusion Gait analysis of FAIS patients after hip arthroscopy demonstrated small, albeit significant, changes in postoperative hip kinetics and kinematics; however, these changes did not correlate with the large, clinically significant improvements in PROs at 1 year after surgery. Clinical Relevance The results of this study suggest that the degree of improvement in short-term PROs after hip arthroscopy for FAIS may not be related to small changes in biomechanics postoperatively.
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Affiliation(s)
- Abhishek S Kannan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Hartwell
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Trevor Grace
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Eric Hammond
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Kylen K J Soriano
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Mastel MS, Federico A, Desy NM, Johnston KD. Femoral de-rotation osteotomy versus hip arthroscopy for management of femoroacetabular impingement in adult patients with decreased femoral anteversion: a matched retrospective cohort study. J Hip Preserv Surg 2022; 9:191-196. [PMID: 35992026 PMCID: PMC9389909 DOI: 10.1093/jhps/hnac033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 06/02/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Femoral de-rotation osteotomy (FDO) and hip arthroscopy are both recognized surgical options for the management of femoroacetabular impingement (FAI) in the setting of decreased femoral anteversion (<5°). Minimal comparative data exist regarding the difference in outcomes between these two techniques, and we believe this is the first study to provide that comparison. This retrospective cohort study included a total of 20 patients with such pathology, matched for age, gender and body mass index. A total of 10 patients were included in the FDO group [median anteversion −0.5° (true retroversion); average follow-up 17.9 months]. In total, 10 patients were included in the hip arthroscopy group [median anteversion −0.5° (true retroversion); average follow-up 28.5 months]. Both groups demonstrated statistically and clinically significant improvement in the post-operative International Hip Outcome Tool (iHOT-33) scores [median improvement: FDO group, 37.7 points (r 14–58.8; P < 0.041); hip arthroscopy group, 35.9 points (r 11.1–81; P < 0.05)], noting that the minimal clinically important difference for the iHOT-33 is 6.1 points. However, the study was not adequately powered to delineate a difference in improvement between the two groups. The findings suggest significant improvement in patient-reported outcomes, and clinical findings can be achieved with either FDO or hip arthroscopy for FAI in the setting of decreased femoral anteversion. However, selection of the most suitable surgical procedure using a patient-specific approach may optimize outcomes in this challenging population.
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Affiliation(s)
- Matthew S Mastel
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan , 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Alyssa Federico
- Faculty of Medicine, University of Calgary , 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nicholas M Desy
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary , 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Alberta Hip and Knee Clinic , #335, 401-9th Ave SW, Calgary, AB T2P 3C5, Canada
| | - Kelly D Johnston
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary , 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Alberta Hip and Knee Clinic , #335, 401-9th Ave SW, Calgary, AB T2P 3C5, Canada
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15
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Martin H, Robinson PG, Maempel JF, Hamilton D, Gaston P, Safran MR, Murray IR. Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2022; 104-B:532-540. [PMID: 35491576 DOI: 10.1302/0301-620x.104b5.bjj-2021-1553.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532-540.
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Affiliation(s)
- Hannah Martin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | | | - David Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
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Filan D, Mullins K, Carton P. Hip Range of Motion Is Increased After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e797-e822. [PMID: 35494261 PMCID: PMC9042900 DOI: 10.1016/j.asmr.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the impact of arthroscopic correction of symptomatic femoroacetabular impingement on postoperative hip range of motion (ROM), as an objectively measured postoperative clinically reported outcome. Methods A systematic review of the current literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, OVID/MEDLINE, EMBASE, and Cochrane databases were queried in November 2020. Studies not reporting pre- to postoperative ROM measurements were excluded. Methodologic quality was assessed using the MINORS assessment, and certainty of evidence was assessed using the GRADE approach. Effect size using standardized mean differences assessed magnitude of change between pre- and postoperative ROM. Results In total, 23 studies were included evaluating 2,332 patients. Mean age ranged from 18 to 44.2 years. Flexion, internal rotation (IR), and external rotation (ER) were the predominantly measured ROMs reported in 91%, 100% and 65% of studies, respectively. Observed change following hip arthroscopy was considered significant in 57.1% (flexion), 74% (IR), and 20% (ER). Effect size of change in significantly improved ROMs were weak (16.7% flexion, 33.3% ER), moderate (58.3% flexion, 29.4% IR), and large (25% flexion, 64.7% IR, 66.7% ER). For goniometric assessment mean observed changes ranged as follows: flexion: 0.1° to 12.2°; IR: 3.6° to 21.9°; ER: –2.6° to 12.8°. For computed tomography–simulated assessment, the mean observed change ranged as follows: flexion: 3.0° to 8.0°; IR 9.3° to 14.0°. Conclusions Outcome studies demonstrate overall increased range of flexion and IR post-hip arthroscopy, with a moderate and large effect respectively. Change in ER is less impacted following hip arthroscopy. Certainty of evidence to support this observation is low. Current research evaluating changes in this functional ability is limited by a lack of prospective studies and non-standardized measurement evaluation techniques. Level of Evidence Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- David Filan
- UPMC Whitfield, Waterford, Ireland
- Address correspondence to David Filan, Suite 5, UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland.
| | | | - Patrick Carton
- Hip and Groin Clinic, Waterford, Ireland
- UPMC Whitfield, Waterford, Ireland
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Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review. Am J Sports Med 2022; 50:1146-1156. [PMID: 34081552 PMCID: PMC8980457 DOI: 10.1177/03635465211011744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. PURPOSE To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. RESULTS Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement (P < .0001), preoperative acetabular index (P = .01), and BMI (P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. CONCLUSION Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany,Filippo Migliorini, MD, MBA, Orthopaedics and Trauma Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, Aachen, 52074, Germany ()
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, UK
| | - Alice Baroncini
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim of the University Heidelberg, Mannheim, Germany
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18
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Wilson DR, Zhang H, Jones CE, Gilbart MK, Masri BA. Effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement. J Orthop Res 2022; 40:370-379. [PMID: 33734474 DOI: 10.1002/jor.25037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
It is not clear whether femoral neck osteochondroplasty achieves its objective of increasing femoroacetabular clearance. We used an upright open magnetic resonance imaging scanner to image the hip joint in multiple postures to explore the effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement. We recruited 13 consecutive patients scheduled to undergo arthroscopic femoral neck osteochondroplasty and completed assessments on 10 patients. We scanned each subject before surgery and at 6 months post-op in supine and 3 other physiological postures: supine 90° flexion with adduction and internal rotation (FADIR), sitting deep (maximal flexion with internal rotation and adduction), and sitting crossed leg (maximal adduction with flexion and internal rotation). We measured the alpha angle, which describes the severity of cam deformity, and the beta angle, which defines joint clearance. We also evaluated hip flexion, internal rotation, and adduction before and after surgery. Femoral neck osteochondroplasty significantly decreased alpha angle by 23.9° ± 4.6° (p = 0.001) and increased beta angle across all postures by 28.1° ± 6.3° (p = 0.002). An increase in beta angle represented a decreased chance of impingement. Femoral neck osteochondroplasty significantly increased flexion by an average of 8.6° in the sitting deep posture after surgery (p = 0.007) which might indicate an improvement of joint function. These findings lend support to the hypothesis that arthroscopic osteochondroplasty accomplishes its stated goals of increasing bone-bone clearance in the hip joint and improving joint mechanics for the static postures assessed.
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Affiliation(s)
- David R Wilson
- Department of Orthopaedics, Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Honglin Zhang
- Department of Orthopaedics, Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carly E Jones
- Centre for Hip Health and Mobility, School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael K Gilbart
- Department of Orthopaedics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, The University of British Columbia, Vancouver, British Columbia, Canada
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19
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Hansen L, de Raedt S, Jørgensen PB, Mygind-Klavsen B, Rømer L, Kaptein B, Søballe K, Stilling M. Hip joint motion does not change one year after arthroscopic osteochondroplasty in patients with femoroacetabular impingement evaluated with dynamic radiostereometry. J Exp Orthop 2022; 9:4. [PMID: 34985680 PMCID: PMC8733129 DOI: 10.1186/s40634-021-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/10/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose Dynamic radiostereometric analysis (dRSA) enables precise non-invasive three-dimensional motion-tracking of bones for assessment of joint kinematics. Hereby, the biomechanical effects of arthroscopic osteochondroplasty of the hip (ACH) can be evaluated in patients with femoroacetabular impingement (FAI). The aim was to investigate the pre- and postoperative range of motion (ROM) and the CT bone volume removed (BV) after ACH. We hypothesize increase in ROM 1 year after surgery. Methods Thirteen patients (6 female) with symptomatic FAI were included prospectively. The patient’s hips were CT-scanned and CT-bone models were created. Preoperative dRSA recordings were acquired during passive flexion to 90°, adduction, and internal rotation (FADIR). ACH was performed, CT and dRSA were repeated 3 months and 1 year postoperatively. Hip joint kinematics before, and 3 months and 1 year after ACH were compared pairwise. The bone volume removal was quantified and compared to change in ROM. Results Mean hip internal rotation, adduction and flexion were all unchanged after ACH at 1-year follow-up (p > 0.84). HAGOS scores revealed improvement of quality of life (QOL) from 32 to 60 (p = 0.02). The BV was between 406 and 1783 mm3 and did not correlate to post-operative ROM. Conclusions ACH surgery in FAI patients had no impact of ROM at 1-year follow-up. QOL improved significantly. This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM. Level of evidence Therapeutic prospective cohort study, level II.
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Affiliation(s)
- Lars Hansen
- Aarhus University Hospital, Aarhus, Denmark.
| | | | | | | | - Lone Rømer
- Aarhus University Hospital, Aarhus, Denmark
| | - Bart Kaptein
- Aarhus University Hospital, Aarhus, Denmark.,Leiden University Medical Center, Leiden, Netherlands
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20
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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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21
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Lee DH, Paley D. Reconstruction of the Hip in Multiple Hereditary Exostoses. CHILDREN-BASEL 2021; 8:children8060490. [PMID: 34201373 PMCID: PMC8229271 DOI: 10.3390/children8060490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/16/2022]
Abstract
The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30-90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck-shaft angle was > 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck-shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz's safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.
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Affiliation(s)
- Dong Hoon Lee
- Donghoon Advanced Lengthening Reconstruction Institute, Superstar tower 3-5F 10, Wiryeseoil-ro, Sujeong-gu, Seongnam-si 11962, Gyeonggi-do, Korea;
| | - Dror Paley
- Paley Orthopedic and Spine Institute, Kimmel, 901 45th St, West Palm Beach, FL 33407, USA
- Correspondence: ; Tel.: +1-561-844-5255; Fax: +1-561-844-5245
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22
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Catelli DS, Bedo BLS, Beaulé PE, Lamontagne M. Pre- and postoperative in silico biomechanics in individuals with cam morphology during stair tasks. Clin Biomech (Bristol, Avon) 2021; 86:105387. [PMID: 34044296 DOI: 10.1016/j.clinbiomech.2021.105387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondroplasty for cam femoroacetabular impingement is a common treatment to improve hip function and prevent joint degeneration. The purpose was to compare in-silico hip biomechanics during stair tasks in pre- and postoperative patients matched with healthy controls. METHODS Ten symptomatic cam femoroacetabular impingement patients performed stair ascent and descent pre- and 2 years postoperatively. Patients were age, and body-mass-index matched to controls. Full-body kinematics and kinetics were computed and, muscle and hip contact forces were estimated using musculoskeletal modeling and static optimization. Stance-phases were time-normalized and compared using statistical non-parametric mapping. FINDINGS Preoperatives showed lower hip abduction than controls during stairs ascent (76-100%, P = .007). Pre- and postoperative showed lower hip external rotation compared to controls on stair ascent (Pre-op vs controls: 71-100%, P = .005; Post-op vs controls: 72-100%, P = .01) and stair descent (Pre-op vs controls: 0-62%, P = .001; Post-op vs controls: 0-60%, P = .001). Postoperatives showed lower iliacus force compared to preoperative (1-3%, P = .012) and control (3-6%, P = .008), and higher gluteus maximus and piriformis forces compared to controls during stair descent. Lower postoperative anterior hip contact force (0-7%, P = .004) during descent, and superior (33-35%, P = .018) during ascent compared to controls were observed. Postoperative contact forces were medialized compared to preoperative (0-2%, P = .011) and controls (1-2%, P = .016). INTERPRETATION Forcing participants to adhere to standardized step length/rise minimized sagittal kinematic differences between conditions and groups. Persistent reduced hip external rotation postoperatively and minor muscle force adaptations led to reduced superior hip contact force during stair ascent and reduced anterior and more medialized contact forces during stair descent.
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Affiliation(s)
| | - Bruno L S Bedo
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
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23
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Lerch TD, Zwingelstein S, Schmaranzer F, Boschung A, Hanke MS, Todorski IAS, Steppacher SD, Gerber N, Zeng G, Siebenrock KA, Tannast M. Posterior Extra-articular Ischiofemoral Impingement Can Be Caused by the Lesser and Greater Trochanter in Patients With Increased Femoral Version: Dynamic 3D CT-Based Hip Impingement Simulation of a Modified FABER Test. Orthop J Sports Med 2021; 9:2325967121990629. [PMID: 34104657 PMCID: PMC8167016 DOI: 10.1177/2325967121990629] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Posterior extra-articular hip impingement has been described for valgus hips
with increased femoral version (FV). These patients can present clinically
with lack of external rotation (ER) and extension and with a positive
posterior impingement test. But we do not know the effect of the combination
of deformities, and the impingement location in early flexion is
unknown. Purpose: To evaluate patient-specific 3-dimensional computed tomography (3D CT) scans
of hips with increased FV and control hips for differences in range of
motion, location and prevalence of osseous posterior intra- and
extra-articular hip impingement. Study Design: Case series; Level of evidence, 4. Methods: Osseous 3D models based on segmentation of 3D CT scans were analyzed for 52
hips (38 symptomatic patients) with positive posterior impingement test and
increased FV (>35°). There were 26 hips with an increased McKibbin
instability index >70 (unstable hips). Patients were mainly female (96%),
with an age range of 18 to 45 years. Of them, 21 hips had isolated increased
FV (>35°); 22 hips had increased FV and increased acetabular version (AV;
>25°); and 9 valgus hips (caput-collum-diaphyseal angle >139°) had
increased FV and increased AV. The control group consisted of 20 hips with
normal FV, normal AV, and no valgus (caput-collum-diaphyseal angle
<139°). Validated 3D CT–based collision detection software for
impingement simulation was used to calculate impingement-free range of
motion and location of hip impingement. Surgical treatment was performed
after the 3D CT–based impingement simulation in 27 hips (52%). Results: Hips with increased FV had significantly (P < .001)
decreased extension and ER at 90° of flexion as compared with the control
group. Posterior impingement was extra-articular (92%) in hips with
increased FV. Valgus hips with increased FV and AV had combined intra- and
extra-articular impingement. Posterior hip impingement occurred between the
ischium and the lesser trochanter at 20° of extension and 20° of ER.
Impingement was located between the ischium and the greater trochanter or
intertrochanteric area at 20° of flexion and 40° of ER, with a modification
of the flexion-abduction-ER (FABER) test. Conclusion: Posterior extra-articular ischiofemoral hip impingement can be caused by the
lesser and greater trochanter or the intertrochanteric region. We recommend
performing the modified FABER test during clinical examination in addition
to the posterior impingement test for female patients with high FV. In
addition, 3D CT can help for surgical planning, such as femoral derotation
osteotomy and/or hip arthroscopy or resection of the lesser trochanter.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sébastien Zwingelstein
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Guodong Zeng
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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24
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Buzzatti L, Keelson B, Vanlauwe J, Buls N, De Mey J, Vandemeulebroucke J, Cattrysse E, Scheerlinck T. Evaluating lower limb kinematics and pathology with dynamic CT. Bone Joint J 2021; 103-B:822-827. [PMID: 33934642 DOI: 10.1302/0301-620x.103b5.bjj-2020-1064.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article: Bone Joint J 2021;103-B(5):822-827.
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Affiliation(s)
- Luca Buzzatti
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Benyameen Keelson
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Johan Vanlauwe
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Erik Cattrysse
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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25
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Mastel MS, El-Bakoury A, Parkar A, Sharma R, Johnston KD. Outcomes of femoral de-rotation osteotomy for treatment of femoroacetabular impingement in adults with decreased femoral anteversion. J Hip Preserv Surg 2021; 7:755-763. [PMID: 34377518 PMCID: PMC8349582 DOI: 10.1093/jhps/hnab031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/01/2021] [Indexed: 11/14/2022] Open
Abstract
Decreased femoral anteversion is an often overlooked factor in femoroacetabular impingement (FAI), with potential to exacerbate both cam and pincer type impingement, or itself be the primary cause. Femoral de-rotation osteotomy (FDO) is a surgical option for symptomatic patients with such underlying bony deformity. This study aimed to investigate outcomes of FDO for management of symptomatic FAI in the presence of decreased (<5°) femoral anteversion. Secondary aims were to describe the surgical technique and assess complications. This study included 33 cases (29 patients) with average pre-operative anteversion measuring –3.1° (true retroversion). At an average follow-up of 1.5 years (19.8 months), 97% reported significant improvement. The overall average post-operative International Hip Outcome Tool (iHOT-33) score of 70.6 points (r: 23–98) compared to the average pre-operative score of 42.8 points (r: 0–56) for the 11 patients with available pre-operative scores suggests an overall improvement. The minimal clinically important difference for the iHOT-33 is 6.1 points. Patients with both pre- and post-operative iHOT-33 scores available demonstrated a statistically and clinically significant improvement of 37.7 (r: 13–70) points. There were three cases (9%) of delayed union and two cases (6%) of non-union early in the series which prompted evolution of the technique. Locking screw removal was performed in 33% of patients for a resultant overall re-operation rate of 45%. The findings suggest improvement in patient-reported outcomes can be achieved with FDO for symptomatic FAI in the setting of decreased femoral anteversion (<5°).
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Affiliation(s)
- M S Mastel
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
- Correspondence to: M.S. Mastel. E-mail:
| | - A El-Bakoury
- Department of Orthopaedics, University Hospitals Plymouth NHS Trust,Derriford Hospital, Derriford Road, Crownhill, Plymouth, Pl68DH, UK
- Department of Orthopaedics, Faculty of Medicine, University of Alexandria, El-Khortoum Square, Alexandria, Egypt
| | - A Parkar
- Department of Orthopaedics, Barking, Havering and Redbridge University Hospital, NHS Trust, Queen's Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - R Sharma
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Alberta Hip and Knee Clinic, 401 9 Ave SW #335, Calgary, AB T2P 3C5, Canada
| | - K D Johnston
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Alberta Hip and Knee Clinic, 401 9 Ave SW #335, Calgary, AB T2P 3C5, Canada
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26
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Lerch TD, Ambühl D, Schmaranzer F, Todorski IAS, Steppacher SD, Hanke MS, Haefeli PC, Liechti EF, Siebenrock KA, Tannast M. Biochemical MRI With dGEMRIC Corresponds to 3D-CT Based Impingement Location for Detection of Acetabular Cartilage Damage in FAI Patients. Orthop J Sports Med 2021; 9:2325967120988175. [PMID: 33816640 PMCID: PMC7988263 DOI: 10.1177/2325967120988175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Anterior femoroacetabular impingement (FAI) is associated with labral tears and acetabular cartilage damage in athletic and young patients. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an imaging method for detecting early damage to cartilage. Purpose We evaluated the following questions: (1) What is the sensitivity and specificity of morphological magnetic resonance imaging (MRI) and dGEMRIC for detecting cartilage damage? Do the mean acetabular and femoral dGEMRIC indices differ between (2) superior acetabular clock positions with and without impingement and (3) between cam- and pincer-type FAI? Study Design Cohort study (diagnosis); Level of evidence, 2. Methods This was a retrospective comparative study of 21 hips (20 patients with symptomatic anterior FAI) without osteoarthritis on anteroposterior radiographs. Morphological MRI and dGEMRIC (3.0-T, 3-dimensional [3D] T1 maps, dual-flip angle technique) of the same hip joint were compared. Intraoperative acetabular cartilage damage was assessed in patients who underwent surgical treatment. Computed tomography (CT)-based 3D bone models of the same hip joint were used as the gold standard for the detection of impingement, and dGEMRIC indices and zones of morphologic damage were compared with the CT-based impingement zones. Results Of the 21 hips, 10 had cam-type FAI and 8 had pincer-type FAI according to radiographs. The mean age was 30 ± 9 years (range, 17-48 years), 71% were female, and surgical treatment was performed in 52%. We found a significantly higher sensitivity (69%) for dGEMRIC compared with morphological MRI (42%) in the detection of cartilage damage (P < .001). The specificity of dGEMRIC was 83% and accuracy was 78%. The mean peripheral acetabular and femoral dGEMRIC indices for clock positions with impingement (485 ± 141 and 440 ± 121 ms) were significantly lower compared with clock positions without impingement (596 ± 183 and 534 ± 129 ms) (P < .001). Hips with cam-type FAI had significantly lower acetabular dGEMRIC indices compared with hips with pincer-type FAI on the anterosuperior clock positions (1 to 3 o'clock) (P = .018). Conclusion MRI with dGEMRIC was more sensitive than morphological MRI, and lower dGEMRIC values were found for clock positions with impingement as detected on 3D-CT. This could aid in patient-specific diagnosis of FAI, preoperative patient selection, and surgical decision making to identify patients with cartilage damage who are at risk for inferior outcomes after hip arthroscopy.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitri Ambühl
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal C Haefeli
- Department of Orthopaedic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Migliorini F, Liu Y, Eschweiler J, Baroncini A, Tingart M, Maffulli N. Increased range of motion but otherwise similar clinical outcome of arthroscopy over open osteoplasty for femoroacetabular impingement at midterm follow-up: A systematic review. Surgeon 2021; 20:194-208. [PMID: 33731304 DOI: 10.1016/j.surge.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND A systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up. MATERIAL AND METHODS This systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting >12 months follow-up were included. RESULTS Data from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P < 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P < 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P < 0.0001). CONCLUSION Based on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
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The Role of Hip Joint Clearance Discrepancy as Other Clinical Predictor of Reinjury and Injury Severity in Hamstring Tears in Elite Athletes. J Clin Med 2021; 10:jcm10051050. [PMID: 33806284 PMCID: PMC7961931 DOI: 10.3390/jcm10051050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Hamstring tear injuries (HTI) are the most prevalent injuries in athletes, with high reinjury rates. To prevent reinjury and reduce the severity of injuries, it is essential to identify potential risk factors. Hip characteristics are fundamental to optimal hamstring function. We sought to investigate the role of hip joint clearance discrepancy (JCD) as a risk factor for HTI and a clinical predictor of risk of reinjury and injury severity. A cross-sectional, retrospective study was performed with elite athletes (n = 100) who did (n = 50) and did not (n = 50) have a history of injury. X-rays were taken to assess JCD. We reviewed muscular lesions historial, and health records for the previous 5 years. Significant differences were found in injury severity (p = 0.026; ŋ2p = 0.105) and a number of injuries (p = 0.003; ŋ2p = 0.172). The multivariate analysis data indicated that JCD was significantly associated with the number of injuries and their severity (p < 0.05). In the stepwise regression model, JCD variability explained 60.1% of the number of injuries (R2 0.601) and 10.5% of injury severity (R2 0.0105). These results suggest that JCD could play an important role as a risk factor for HTI and also as a clinical predictor of reinjury and injury severity.
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29
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Abstract
Femoroacetabular impingement and associated labral tearing is a common source of hip pain in athletes. This article reviews the hip joint anatomy and complex interplay between alterations on the femoral and acetabular sides, in addition to evaluation of soft tissue stabilizers and spinopelvic parameters. Symptom management with a focus on arthroscopic treatment of abnormal bony morphology and labral repair or reconstruction is discussed. In select patients with persistent pain who have failed conservative measures, hip arthroscopy with correction of bony impingement and labral repair or reconstruction has yielded good to excellent results in recreational and professional athletes.
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30
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Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities. Knee Surg Sports Traumatol Arthrosc 2021; 29:2825-2836. [PMID: 34228156 PMCID: PMC8384823 DOI: 10.1007/s00167-021-06643-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/11/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. METHODS A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. RESULTS A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported 'normal' mean version values (10-25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. CONCLUSION Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. LEVEL OF EVIDENCE IV.
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31
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Wininger AE, Barter LE, Boutris N, Pulido LF, Ellis TJ, Nho SJ, Harris JD. Hip arthroscopy for lateral cam morphology: how important are the vessels? J Hip Preserv Surg 2020; 7:183-194. [PMID: 33163203 PMCID: PMC7605776 DOI: 10.1093/jhps/hnaa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/17/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this narrative review is to identify the anatomy and relevant blood supply to the femoral head as it pertains to hip arthroscopy and lateral cam morphology. The primary blood supply to the femoral head is the lateral ascending superior retinacular vessels, which are terminal branches of the medial femoral circumflex artery. These vessels penetrate the femoral head at the posterolateral head–neck junction. Surgeons performing posterolateral femoral osteoplasty must respect this vasculature to avoid iatrogenic avascular necrosis (AVN). Avoidance of excessive traction, avoidance of distal posterolateral capsulotomy and avoidance of disruption of the superior retinacular vessels should keep the risk for AVN low. Hip extension, internal rotation and distraction are useful in hip arthroscopy to better visualize lateral/posterolateral cam morphology to facilitate an accurate comprehensive cam correction and avoid vascular disruption.
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Affiliation(s)
- Austin E Wininger
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Lindsay E Barter
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Nickolas Boutris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Luis F Pulido
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Thomas J Ellis
- Orthopedic One, 4605 Sawmill Road, Upper Arlington, OH 43220, USA
| | - Shane J Nho
- Midwest Orthopedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
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Catelli DS, Ng KCG, Wesseling M, Kowalski E, Jonkers I, Beaulé PE, Lamontagne M. Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery. J Bone Joint Surg Am 2020; 102:34-42. [PMID: 32870617 DOI: 10.2106/jbjs.20.00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to compare muscle forces and hip contact forces (HCFs) during squatting in patients with cam-type femoroacetabular impingement (cam-FAI) before and after hip corrective surgery and with healthy control participants. METHODS Ten symptomatic male patients with cam-FAI performed deep squatting preoperatively and at 2 years postoperatively. Patients were matched by age and body mass index to 10 male control participants. Full-body kinematics and kinetics were computed, and muscle forces and HCFs were estimated using a musculoskeletal model and static optimization. Normalized squat cycle (%SC) trials were compared using statistical nonparametric mapping (SnPM). RESULTS Postoperatively, patients with cam-FAI squatted down with higher anterior pelvic tilt, higher hip flexion, and greater hip extension moments than preoperatively. Preoperative patients demonstrated lower anterior pelvic tilt and lower hip flexion compared with the participants in the control group. Postoperative patients showed increased semimembranosus force compared with their preoperative values. Preoperative forces were lower than the control group for the adductor magnus, the psoas major, and the semimembranosus; however, the preoperative patients showed greater inferior gluteus maximus forces than the patients in the control group, whereas the postoperative patients did not differ from the control patients. Higher posterior, superior, and resultant HCF magnitudes were identified postoperatively in comparison with the preoperative values. Preoperative posterior HCF was lower than in the control group, whereas the postoperative posterior HCF did not differ from those in the control group. CONCLUSIONS Higher postoperative anterior pelvic tilt was associated with an indication of return to closer to normal pelvic motion, which resembled data from the control group. Lower preoperative anterior pelvic tilt was associated with muscle force imbalance, indicated by decreased semimembranosus and increased gluteus maximus forces. The overall increased postoperative muscle forces were associated with improved pelvic mobility and increased HCFs that were comparable with the control-group standards. CLINICAL RELEVANCE Muscle forces and HCFs may be indicative of postoperative joint health restoration and alleviated symptoms.
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Affiliation(s)
- Danilo S Catelli
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - K C Geoffrey Ng
- MSk Lab, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | | | - Erik Kowalski
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Paul E Beaulé
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Mario Lamontagne
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
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Bagce H, Lynch TS, Wong TT. Use of a 3D virtual dynamic hip model to quantify the amount of osteoplasty required in femoroacetabular impingement patients. Clin Imaging 2020; 69:293-300. [PMID: 33045473 DOI: 10.1016/j.clinimag.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Compare required osteoplasty predicted by a 3D virtual dynamic hip model in femoroacetabular impingement patients to actual osteoplasty performed. MATERIALS AND METHODS Retrospective study on 20 consecutive FAI patients with a preoperative CT who underwent arthroscopy from October 2016 to September 2017. A 3D virtual dynamic hip model was created from the CT. The model displayed virtual osteoplasty depth required to restore physiologic range of motion on an osteoplasty map. Depths of virtual osteoplasty and actual osteoplasty at surgery were compared and correlated with alpha angle, lateral center edge angle, femoral version, and acetabular version. RESULTS Actual femoroplasty depth correlated with alpha angle (r = 0.85, p ≤ 0.001) and actual acetabuloplasty depth correlated with lateral center edge angle (r = 0.83, p < 0.001). Virtual osteoplasty depth did not correlate with alpha angle (p = 0.25), lateral center edge angle (p = 0.50), femoral version (p = 0.09), or acetabular version (p = 0.09). The 3D model predicted a mean virtual osteoplasty of 6.2 ± 0.3 mm compared to mean actual osteoplasty of 5.9 ± 1.1 mm. There was no significant difference between the two means (p = 0.26), though there was a significant difference in variance (p = 0.001). There was poor test reliability between virtual osteoplasty compared with actual osteoplasty (ICC = 0.30). CONCLUSION 3D model predicted virtual osteoplasty depths varied with actual osteoplasty and was independent of 2D measurements.
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Affiliation(s)
- Hamid Bagce
- NewYork-Presbyterian Hospital Columbia University Medical Center, Department of Radiology, 622 West 168th Street, MC-28, New York, NY 10032, United States of America
| | - Thomas S Lynch
- NewYork-Presbyterian Hospital Columbia University Medical Center, Department of Orthopedics, The Center for Shoulder, Elbow, and Sports Medicine, 622 West 168th Street, PH-11, New York, NY 10032, United States of America
| | - Tony T Wong
- NewYork-Presbyterian Hospital Columbia University Medical Center, Department of Radiology, 622 West 168th Street, MC-28, New York, NY 10032, United States of America.
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Han S, Owens VL, Patel RV, Ismaily SK, Harrington MA, Incavo SJ, Noble PC. The continuum of hip range of motion: From soft-tissue restriction to bony impingement. J Orthop Res 2020; 38:1779-1786. [PMID: 31965588 DOI: 10.1002/jor.24594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
Traditional studies of hip kinematics have not identified which anatomic structures limit the range of motion (ROM) when the hip is placed in different maneuvers. In this study, we attempted to answer two questions: (a) During which maneuvers is the motion of the hip limited by bony impingement between the femur and pelvis? (b) When is hip ROM determined by the constraint of soft tissues and to what extent? ROM of eight cadaveric hips was measured in 17 maneuvers using a motion capture system. The maneuvers were recreated in silico using 3D CT models of each specimen to detect the occurrence of bony impingement. If bony impingement was not detected, the variable component of 3D hip motion was increased until a collision was detected. The difference between the virtual ROM at the point of bony impingement and the initial ROM measured experimentally was termed as the soft-tissue restriction. The results showed that bony impingement was present in normal hips during maneuvers consisting of high abduction with flexion, and high flexion combined with adduction and internal rotation. At impingement-free maneuvers, the degree of soft tissue restriction varies remarkably, ranging from 4.9° ± 3.8° (internal rotation) at 90° of flexion to 80.0° ± 12.5° (internal rotation) at maximum extension. The findings shed light on the relative contributions of osseous and soft tissues to the motion of the hip in different maneuvers and allow for a better understanding of physical exams of different purposes in diagnosing bone- or soft tissue-related diseases.
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Affiliation(s)
- Shuyang Han
- Institute of Orthopedic Research and Education, Houston, Texas.,McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Rikin V Patel
- Institute of Orthopedic Research and Education, Houston, Texas
| | - Sabir K Ismaily
- Institute of Orthopedic Research and Education, Houston, Texas.,McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Melvyn A Harrington
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Philip C Noble
- Institute of Orthopedic Research and Education, Houston, Texas.,Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
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Blair DJ, Barg A, Foreman KB, Anderson AE, Lenz AL. Methodology for Measurement of in vivo Tibiotalar Kinematics After Total Ankle Replacement Using Dual Fluoroscopy. Front Bioeng Biotechnol 2020; 8:375. [PMID: 32432091 PMCID: PMC7214754 DOI: 10.3389/fbioe.2020.00375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Biomechanical data could improve our clinical understanding of failures in total ankle replacement (TAR) patients, leading to better surgical approaches and implant designs. Kinematics of the prosthetic tibiotalar joint in TAR patients have yet to be measured using dual fluoroscopy. With dual fluoroscopy, computed tomography (CT) images are acquired to track bone motion. One challenge with this approach is dealing with metal artifact in the CT images that distorts implant visualization and the surrounding bone to implant interfaces. The aim of this study was to develop a methodology to measure in vivo TAR kinematics using inputs of computer-aided design (CAD) models, dual fluoroscopy and CT imaging with metal artifact reduction. To develop this methodology, we created a hybrid three-dimensional (3D) model that contained both: (1) the segmented bone; and (2) the CAD models of the TAR components. We evaluated a patient following total ankle replacement to demonstrate feasibility. The patient performed a self-selected overground walk during which dual fluoroscopy images were collected at 200 Hz. In vivo tracking verifications were performed during overground walking using a distance calculation between the implant articular surfaces to evaluate the model-based tracking 3D solution. Tracking verification indicated realistic alignment of the hybrid models with an evenly distributed distance map pattern during the trial. Articular surface distance calculations were reported as an average of 1.3 mm gap during the entirety of overground walking. The successful implementation of our new tracking methodology with a hybrid model presents a new approach to evaluate in vivo TAR kinematics. Measurements of in vivo kinematics could improve our clinical understanding of failures in TAR patients, leading to better long-term surgical outcomes.
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Affiliation(s)
- Dylan J Blair
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Alexej Barg
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
| | - K Bo Foreman
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States
| | - Andrew E Anderson
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Amy L Lenz
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
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36
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Cannon J, Weber AE, Park S, Mayer EN, Powers CM. Pathomechanics Underlying Femoroacetabular Impingement Syndrome: Theoretical Framework to Inform Clinical Practice. Phys Ther 2020; 100:788-797. [PMID: 31899497 DOI: 10.1093/ptj/pzz189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/16/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts.
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Affiliation(s)
- Jordan Cannon
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Seol Park
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erik N Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Christopher M Powers
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar St, CHP-155, Los Angeles, CA (USA)
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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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Lerch TD, Siegfried M, Schmaranzer F, Leibold CS, Zurmühle CA, Hanke MS, Ryan MK, Steppacher SD, Siebenrock KA, Tannast M. Location of Intra- and Extra-articular Hip Impingement Is Different in Patients With Pincer-Type and Mixed-Type Femoroacetabular Impingement Due to Acetabular Retroversion or Protrusio Acetabuli on 3D CT-Based Impingement Simulation. Am J Sports Med 2020; 48:661-672. [PMID: 31961701 DOI: 10.1177/0363546519897273] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diagnosis and surgical treatment of hips with different types of pincer femoroacetabular impingement (FAI), such as protrusio acetabuli and acetabular retroversion, remain controversial because actual 3-dimensional (3D) acetabular coverage and location of impingement cannot be studied via standard 2-dimensional imaging. It remains unclear whether pincer hips exhibit intra- or extra-articular FAI. PURPOSE (1) To determine the 3D femoral head coverage in these subgroups of pincer FAI, (2) determine the impingement-free range of motion (ROM) through use of osseous models based on 3D-computed tomography (CT) scans, and (3) determine the osseous intra-and extra-articular 3D impingement zones by use of 3D impingement simulation. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This is a retrospective, comparative, controlled study involving 70 hips in 50 patients. There were 24 patients (44 hips) with symptomatic pincer-type or mixed-type FAI and 26 patients (26 hips) with normal hips. Surface models based on 3D-CT scans were reconstructed and compared for hips with acetabular retroversion (30 hips), hips with protrusio acetabuli (14 hips), and normal asymptomatic hips (26 hips). Impingement-free ROM and location of impingement were determined for all hips through use of validated 3D collision detection software based on CT-based 3D models. No abnormal morphologic features of the anterior iliac inferior spine were detected. RESULTS (1) Mean total femoral head coverage was significantly (P < .001) increased in hips with protrusio acetabuli (92% ± 7%) and acetabular retroversion (71% ± 5%) compared with normal hips (66% ± 6%). (2) Mean flexion was significantly (P < .001) decreased in hips with protrusio acetabuli (104°± 9°) and acetabular retroversion (116°± 6°) compared with normal hips (125°± 13°). Mean internal rotation in 90° of flexion was significantly (P < .001) decreased in hips with protrusio acetabuli (16°± 12°) compared with normal hips (35°± 13°). (3) The prevalence of extra-articular subspine impingement was significantly (P < .001) higher in hips with acetabular retroversion (87%) compared with hips with protrusio acetabuli (14%) and normal hips (0%) and was combined with intra-articular impingement. The location of anterior impingement differed significantly (P < .001) between hips with protrusio acetabuli and normal hips. CONCLUSION Using CT-based 3D hip models, we found that hips with pincer-type and mixed-type FAI have significantly larger femoral head coverage and different osseous ROM and location of impingement compared with normal hips. Additionally, intra- and extra-articular subspine impingement was detected predominantly in hips with acetabular retroversion. Acetabular rim trimming during hip arthroscopy or open surgical hip dislocation should be performed with caution for these hips. Patient-specific analysis of location of impingement using 3D-CT could theoretically improve diagnosis and planning of surgical treatment.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Mathias Siegfried
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,University Institute of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Christiane S Leibold
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Corinne A Zurmühle
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Michael K Ryan
- American Sports Medicine Institute, Andrews Orthopaedic and Sports Medicine Center, Birmingham, Alabama, USA
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Lee JK, Hwang DS, Kang C, Hwang JM, Lee GS, Zeng L, Park YC. Midterm-clinical Outcomes after Hip Arthroscopy in Middle-aged Patients with Early Osteoarthritis. Hip Pelvis 2020; 32:17-25. [PMID: 32158725 PMCID: PMC7054075 DOI: 10.5371/hp.2020.32.1.17] [Citation(s) in RCA: 2] [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: 09/25/2019] [Revised: 11/01/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Although the number of hip arthroscopies is rapidly increasing in non-elderly patients, outcomes of this procedure in middle-aged patients are not well documented or clearly understood. The purpose of this study was to evaluate the clinical and radiological outcomes after hip arthroscopy in middle-aged patients with early osteoarthritis. Materials and Methods This retrospective study analyzed 189 patients with early osteoarthritis of various diagnoses aged 40 years or older who underwent hip arthroscopy between January 2010 and December 2015. Clinical (e.g., modified Harris hip score [mHHS], hip outcome score-activities of daily living [HOS-ADL], visual analogue scale [VAS] for pain, range of motion) and radiological (change of Tönnis grade) outcomes were assessed at a minimum of 3-year follow-up. Results The mean preoperative and final mHHS and HOS-ADL improved from 61.2 and 60.6 to 79.5 and 81.8, respectively, while the VAS pain score decreased from 6.3 to 3.2 (P<0.001). Although the mean range of internal rotation and flexion increased from 14.2 and 100.7° preoperatively to 30.4 and 110.6° at 1-year postoperatively, they decreased slightly to 27.4 and 105.4° at the final follow-up, respectively. Eight cases (4.2%) underwent revision arthroscopic surgery and three cases (1.6%) were converted to total hip arthroplasty. Conclusion Patients with early-stage osteoarthritis of various diagnoses achieved improved clinical outcomes. Therefore, using hip arthroscopy in middle-aged patients with early osteoarthritis, it is possible to achieve good surgical options.
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Affiliation(s)
- Jeong-Kil Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Kang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jung-Mo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gi-Soo Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Long Zeng
- Department of Orthopaedic Surgery, Yanbian University Hospital, Yanji, China
| | - Young-Cheol Park
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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Cvetanovich GL, Farkas GJ, Beck EC, Malloy P, Jan K, Espinoza-Orias A, Nho SJ. Squat and gait biomechanics 6 months following hip arthroscopy for femoroacetabular impingement syndrome. J Hip Preserv Surg 2020; 7:27-37. [PMID: 32382426 PMCID: PMC7195932 DOI: 10.1093/jhps/hnaa004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to (i) assess whether squat and gait biomechanical measures improve in patients with femoroacetabular impingement syndrome (FAIS) 6 months after surgery compared to pre-operative measures and (ii) compare biomechanical properties to controls without FAIS. In this prospective study, biomechanical data during a double leg squat task and gait for 15 FAIS patients and 9 controls were collected using three-dimensional motion analysis. Data were collected in the FAIS group at two-time points, pre-operatively and 6-month post-operatively following arthroscopic hip surgery, and at a single time point for the healthy controls. Independent sample's t-test were used to compare the FAIS group to the controls, and paired samples t-test were used to determine within-group differences before and after hip arthroscopy in the FAIS group. The results indicated that there were significant within-group increases for sagittal plane moment rate during the double leg squat task (P = 0.009) between the pre-operative and post-operative time points for the FAIS group. Between-group differences showed that FAIS patients pre-operatively exhibit slower squat velocities during the descent (P = 0.005) and ascent phase (P = 0.012) of a double leg squat when compared healthy controls. Reduced hip external rotation moments during gait (P = 0.02) were also found between FAIS patients pre-operatively and controls. In conclusion, alterations in hip biomechanics are present before surgery for FAIS when compared to healthy controls, and joint mechanics change 6 months after surgery. However, the biomechanical differences during a double leg squat and gait were minimal.
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Affiliation(s)
- Gregory L Cvetanovich
- Department of Orthopedic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gary J Farkas
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
| | - Edward C Beck
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Philip Malloy
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Kyleen Jan
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Alejandro Espinoza-Orias
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
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Cho SH, Cho HJ, Cho YJ. Surgical hip dislocation and varus derotation osteotomy for extra-articular cause of femoroacetabular impingement: a single case report. J Hip Preserv Surg 2020; 7:153-159. [PMID: 32382443 PMCID: PMC7195939 DOI: 10.1093/jhps/hnz071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 12/26/2019] [Indexed: 12/02/2022] Open
Abstract
Femoral retroversion is an extra-articular cause of cam-type femoroacetabular impingement (FAI) via early engagement with anterior rim. Valgus hip also causes extra-articular FAI by decreasing the range of motion. We present a case of valgus hip accompanied by femoral retroversion, which was refractory to prior arthroscopic femoroplasty. As a reasonable strategy, we have performed extra-articular correction via femoral subtrochanteric varus derotation osteotomy as well as intra-articular decompression by surgical hip dislocation. Femoral varus derotation osteotomy with surgical hip dislocation is a rational and appropriate solution in patients with extra-articular FAI, which is refractory to arthroscopic FAI surgery. Extra-articular causes of FAI should be suspected in every refractory case.
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Affiliation(s)
- Su-Hyun Cho
- Department of Orthopaedic Surgery, Andong General Hospital, Angsilro 11, Soo-Sang-Dong, Andongsi, Kyoung-Sang-Book-Do, South Korea
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Hamula MJ, Ryan MK, Baron SL, Bloom DA, Youm T. Atypical Hip Pain in Femoroacetabular Impingement: A Comparison of Outcomes Based on Primary Hip Pain Location. Am J Sports Med 2020; 48:167-172. [PMID: 31765225 DOI: 10.1177/0363546519887733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with symptomatic femoroacetabular impingement (FAI) typically have anterior groin pain. However, a subset of these patients may have pain located laterally, posteriorly, or in a combination of locations around the hip. PURPOSE To report and compare outcomes of hip arthroscopy for patients with FAI and atypical hip pain versus classic anterior groin pain. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Consecutive patients undergoing hip arthroscopy for FAI between August 2011 and March 2013 were identified. A total of 258 patients were identified as having symptomatic FAI based on clinical, radiographic, and advanced imaging diagnosis of FAI. Exclusion criteria included isolated thigh, knee, or low back pain. We also excluded patients with hip abductor pathology and trochanteric bursitis. Of the 226 patients ultimately included, 159 (70.4%) reported anterior groin pain, while 67 (29.6%) reported isolated lateral or posterior hip pain or a combination of locations. Patients were categorized into 4 groups: isolated anterior groin pain, lateral hip pain, posterior hip pain, and multiple primary hip pain locations (combined). These patients were followed prospectively with a minimum follow-up of 2 years. Patient characteristics, surgical characteristics, modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), revision hip arthroscopy, and conversions to total hip arthroplasty (THA) were recorded. RESULTS All 226 patients were included at final follow-up. Hip arthroscopy was performed by a single sports medicine fellowship-trained orthopaedic surgeon. Preoperative patient characteristics and baseline functional outcome scores did not significantly differ among groups. All 4 groups showed statistically significant improvements in mHHS and NAHS from baseline to final follow-up of a mean 2.63 years (range, 2.01-3.23 years). Functional outcome scores and rates of revision hip arthroscopy or conversion to THA did not significantly differ between groups. CONCLUSION Hip arthroscopy can effectively improve patient outcomes in atypical hip pain. A careful history and physical examination should identify this clinically meaningful subset of patients with FAI who can benefit from surgical intervention while identifying patients with concomitant posterior extra-articular hip or spine pathology that should be addressed appropriately.
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Affiliation(s)
| | - Michael K Ryan
- NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Samuel L Baron
- NYU Langone Orthopedic Hospital, New York, New York, USA
| | - David A Bloom
- NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Thomas Youm
- NYU Langone Orthopedic Hospital, New York, New York, USA
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Ferraz A, Fontana HDB, Castro MPD, Ruschel C, Pierri CAA, Roesler H. Hip morphology and its relationship with hip strength, mobility and lower limb biomechanics: a systematic review in adults. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2020. [DOI: 10.1590/1980-0037.2020v22e67085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This systematic review (PROSPERO registration n.43640) aimed to summarise and determine the quality of evidence relating hip bone morphology to (i) hip strength, (ii) mobility and (iii) lower limb biomechanics during functional activities. A standardized search on MEDLINE/PubMed, Web of Science, ScienceDirect and Scopus resulted in 17 papers that met inclusion criteria: i) original investigations with a minimal sample of n=10, ii) studies on humans and iii) presence of at least one quantitative hip morphological parameter and one hip functional (i.e. strength and mobility) and/or one lower limb biomechanical parameter. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool with adaptations. Sixteen out of the 17 included studies showed high risk of bias. We observed that primary evidence pointed to the influence of hip morphology on hip mobility in the transverse plane. Specifically, positive correlations between femoral anteversion angle and range of internal hip rotation in physical examination were observed. Regarding biomechanical parameters, no clear evidence of association between hip morphology, and kinematic and kinetic parameters were found. Our results point to a field that is currently under explored and future studies with low risk of bias addressing these relationships are required.
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Lerch TD, Boschung A, Todorski IAS, Steppacher SD, Schmaranzer F, Zheng G, Ryan MK, Siebenrock KA, Tannast M. Femoroacetabular Impingement Patients With Decreased Femoral Version Have Different Impingement Locations and Intra- and Extraarticular Anterior Subspine FAI on 3D-CT-Based Impingement Simulation: Implications for Hip Arthroscopy. Am J Sports Med 2019; 47:3120-3132. [PMID: 31539275 DOI: 10.1177/0363546519873666] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains unclear whether decreased femoral version (FV) causes anterior intra- or extra-articular femoroacetabular impingement (FAI). Therefore, we evaluated symptomatic hips with decreased FV, with and without cam and pincer FAI, by using computed tomography (CT)-based virtual 3-dimensional (3D) impingement simulation and compared this group with patients with normal FV and with asymptomatic hips. PURPOSE To investigate (1) the osseous range of motion, (2) the osseous femoral and acetabular impingement zones, and (3) whether hip impingement is extra- or intra-articular in symptomatic hips with FAI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS An institutional review board-approved, retrospective comparative analysis was performed on a total of 84 hips in 68 participants. Of these, 37 hips in 24 symptomatic patients with FAI had decreased FV. These hips were compared with 21 hips of 18 symptomatic patients with anterior FAI with normal FV (10°-25°) and 26 asymptomatic hips with no FAI and normal FV. All patients with FAI were symptomatic and had anterior hip pain and a positive anterior impingement test. They underwent pelvic CT scans to measure FV. Decreased FV was defined as FV less than 5°. The 37 hips with decreased FV presented both with and without cam and pincer FAI. All 84 hips were evaluated by use of CT-based 3D models and a validated 3D range of motion and impingement simulation. Asymptomatic hips were contralateral normal hips imaged in patients undergoing total hip arthroplasty. RESULTS Hips with FAI combined with decreased FV had a significantly (P < .001) lower mean flexion (114°± 8° vs 125°± 13°) and internal rotation (IR) at 90° of flexion (18°± 6° vs 32°± 9°, P < .001) compared with the asymptomatic control group. Symptomatic patients with FAI and normal FV had flexion of 120°± 16° and IR at 90° of flexion of 23°± 15°. In a subgroup analysis, we found a significantly (P < .001) lower IR in 90° of flexion in hips with FV less than 5° combined with mixed-type FAI compared with hips with FV less than 5° without a cam- or pincer-type deformity. The maximal acetabular impingement zone for hips with decreased FV was located at the 2-o'clock position and ranged from 1 to 3 o'clock. In hips with decreased FV, most of the impingement locations were intra-articular but 32% of hips had combined intra- and extra-articular FAI in internal rotation in 90° of flexion. During the flexion-adduction-IR test performed in 10° and 20° of adduction, extra-articular subspine FAI had significantly (P < .001) higher prevalence (68% and 84%) in hips with decreased FV compared with normal hips. CONCLUSION Hips with FAI and decreased FV had less flexion and internal rotation in 90° of flexion compared with the asymptomatic control group. The majority of hip impingement due to low FV was intra-articular, but one-third of samples had combined intra- and extra-articular subspine FAI. Anterior extra- and intra-articular hip impingement can be present in patients who have FAI with decreased FV. This could be important for patients undergoing hip arthroscopy.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Guoyan Zheng
- ISTB, Institute for Surgical Techniques and Biomechanics, University of Bern, Bern, Switzerland
| | - Michael K Ryan
- American Sports Medicine Institute, Andrews Orthopaedic and Sports Medicine Center, Birmingham, Alabama, USA
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Macdonald B, McAleer S, Kelly S, Chakraverty R, Johnston M, Pollock N. Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice. Br J Sports Med 2019; 53:1464-1473. [DOI: 10.1136/bjsports-2017-098971] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
RationaleHamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.ObjectiveWe present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.
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Catelli DS, Kowalski E, Beaulé PE, Lamontagne M. Increased pelvic mobility and altered hip muscles contraction patterns: two-year follow-up cam-FAIS corrective surgery. J Hip Preserv Surg 2019; 6:140-148. [PMID: 31660199 PMCID: PMC6662956 DOI: 10.1093/jhps/hnz019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/11/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022] Open
Abstract
Femoroacetabular impingement syndrome (FAIS) surgery can produce improvements in function and patient satisfaction; however, data on muscle assessment and kinematics of high mobility tasks of post-operative patients is limited. The purpose of this study was to evaluate kinematics and muscle activity during a deep squat task, as well as muscle strength in a 2-year follow-up FAIS corrective surgery. Eleven cam morphology patients underwent motion and electromyography capture while performing a squat task prior and 2-years after osteochondroplasty and were BMI-, age- and sex-matched to 11 healthy control (CTRL) participants. Isometric muscle strength, flexibility and patient-reported outcome measures (PROMs) were also evaluated. Post-operative FAIS was significantly weaker during hip flexion (23%) and hip flexion-with-abduction (25%) movements when compared with CTRL, no improvements in squat depth were observed. However, post-operative FAIS increased the pelvic range of motion during the squat descent (P = 0.016) and ascent (P = 0.047). They had greater peak activity for the semitendinosus and total muscle activity for the gluteus medius, but decreased peak activity for the glutei and rectus femoris during squat descent; greater total muscle activity for the tensor fascia latae was observed during squat ascent (P = 0.005). Although not improving squat depth, post-operative patients increased pelvic ROM and showed positive PROMs. The muscle weakness associated with hip flexion and flexion-with-abduction observed at the follow-up can be associated with the alterations in the muscle activity and neuromuscular patterns. Rehabilitation programs should focus on increasing pelvis and hip muscles flexibility and strength.
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Affiliation(s)
- Danilo S Catelli
- School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada.,Ministry of Education of Brazil, CAPES Foundation, Brasilia, DF, Brazil
| | - Erik Kowalski
- School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 501 Smyth Road (028A), Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 501 Smyth Road (028A), Canada.,Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, 800 King Edward Ave, Canada
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47
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Larson CM, McGaver RS, Collette NR, Giveans MR, Ross JR, Bedi A, Nepple JJ. Arthroscopic Surgery for Femoroacetabular Impingement in Skeletally Immature Athletes: Radiographic and Clinical Analysis. Arthroscopy 2019; 35:1819-1825. [PMID: 31072717 DOI: 10.1016/j.arthro.2019.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate radiographic and clinical outcomes after arthroscopic femoroacetabular impingement (FAI) correction in symptomatic adolescent athletes with open physes. METHODS We retrospectively reviewed radiographic and clinical outcomes in patients treated with a non-physeal-sparing arthroscopic approach for symptomatic FAI with open physes and a minimum 1-year follow-up. Specific plain radiographic and computed tomography parameters were determined, and preoperative and postoperative outcomes were prospectively evaluated with modified Harris Hip Score (mHHS), 12-Item Veterans-Rand, and pain on a visual analog scale. RESULTS Thirty-seven hips (28 patients; 75% male) with a mean age of 15.9 years (range, 12.8-18.3 years) had imaging studies consistent with open femoral neck and iliac crest physes. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips, respectively. All patients participated in organized athletics, and 50% were in multiple sports year-round. Mean follow-up was 39.8 months post-arthroscopic FAI correction. There was a mean 27.7-point improvement in the mHHS (P < .001), a 4.8-point decrease in the visual analog scale for pain (P < .001), and a 15.2-point improvement in the 12-Item Veterans-Rand physical component (P < .001). Ninety-three percent of patients returned to their preinjury level of sports participation without limitations. Thirty (81.1%) patients demonstrated improvements in mHHS greater than the minimally clinically important difference (of mHHS 8 points). Two patients could not reach minimally clinically important difference because of a preoperative mHHS of > 92. There were no postoperative physeal growth arrests, growth disturbances, physeal instability, or avascular necrosis. CONCLUSIONS A non-physeal-sparing arthroscopic approach for FAI in adolescents with open physes is safe and effective with no evidence of clinically relevant complication of growth arrest-related deformity or physeal instability in patients with a minimum of 1 year (mean, 39.8 months) of follow-up after surgery. Young, highly athletic adolescent patients with larger FAI deformities demonstrated greater outcomes improvement after arthroscopy. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | - James R Ross
- BocaCare Orthopedics, Deerfield Beach, Florida, U.S.A
| | - Asheesh Bedi
- University of Michigan MedSport, Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, U.S.A
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Moley PJ, Gribbin CK, Vargas E, Kelly BT. Co-diagnoses of spondylolysis and femoroacetabular impingement: a case series of adolescent athletes. J Hip Preserv Surg 2018; 5:393-398. [PMID: 30647930 PMCID: PMC6328847 DOI: 10.1093/jhps/hny040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 09/10/2018] [Accepted: 10/20/2018] [Indexed: 12/27/2022] Open
Abstract
Locating the source of lumbopelvic–hip pain requires the consideration of multiple clinical pathways. Although low back pain has an incidence of 50% in the adolescent population, the pathophysiology in this population typically differs from that of other age groups. Dynamic mechanical impairments of the hip, such as femoroacetabular impingement, may contribute to the pathogenesis of adolescent low back pain. Eight adolescent male athletes who presented to a single provider with a primary complaint of low back pain with hip pain or motion loss on exam and were ultimately diagnosed with lumbar spondylolysis and dynamic mechanical hip issues between 2009 and 2011 were included. The age at spondylolysis diagnosis ranged from 15 to 19 years (mean ± standard deviation: 16.3 ± 1.3 years). Seven patients had cam-type impingement, whereas one presented with pincer-type impingement. All patients demonstrated either decreased internal rotation at 90 degrees of hip flexion and neutral abduction or pain on the Flexion Adduction Internal Rotation test on at least one of hip. All eight patients were treated initially with 6 weeks of physical therapy consisting of attempted restoration of hip motion and the graduated progression of hip and spine stabilization exercises. Five patients (62.5%) returned to sport at an average of 11.2 weeks (range: 6–16 weeks). For three patients (37.5%), hip pain and motion loss persisted, thus requiring surgery. All subjects had symptoms for at least 6 weeks, with 6 months as the longest duration. This report is the first documented series of adolescent athletes with co-diagnoses of spondylolysis and femoroacetabular impingement. Study Information: This retrospective case series was approved by the Institutional Review Board at Hospital for Special Surgery.
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Affiliation(s)
- Peter J Moley
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Caitlin K Gribbin
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Elizabeth Vargas
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Bryan T Kelly
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Sochacki KR, Yetter TR, Morehouse H, Delgado D, Nho SJ, Harris JD. The Risk of Impingement With Sexual Activity in Femoroacetabular Impingement Syndrome Due to Cam Morphology: Shape Matters. Orthop J Sports Med 2018; 6:2325967118791790. [PMID: 30159357 PMCID: PMC6109868 DOI: 10.1177/2325967118791790] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Sexual difficulties and dysfunction are common in patients with femoroacetabular impingement syndrome (FAIS) secondary to hip pain and stiffness. Purpose: To determine the risk of impingement in patients with FAIS during common sexual positions using 3-dimensional computer-simulated collision detection before and after cam correction. Study Design: Descriptive laboratory study. Methods: Ten computed tomography scans of the pelvis and femur from patients with FAIS due to isolated cam morphology were retrospectively reviewed. Three-dimensional osseous models were developed using Mimics software. The cam deformity was then completely corrected. Simulations of hip range of motion for the most common sexual positions for men (n = 15) and women (n = 14) were conducted before and after cam resection. Impingement was determined for each sexual position. Position safety was defined as ≤20% of models demonstrating impingement in a position. Descriptive and simple comparative statistics were calculated. Results: There was no sexual position that was impingement free in all models before cam correction. After cam correction, 11 (37.9%) of 29 total positions were impingement free. There was a significant decrease in impingement from before to after cam correction (40.7% vs 11.4%, respectively, of all female positions [P < .0001]; 26.0% vs 6.7%, respectively, of all male positions [P < .0001]). There was a significant increase in the number of “safe” positions from before to after cam correction (4 vs 11, respectively, of all female positions [P = .008]; 7 vs 15, respectively, of all male positions [P = .001]). Conclusion: After cam correction, there was a significant reduction in the impingement rate and a significant increase in the number of “safe” sexual positions. Clinical Relevance: Impingement in patients with cam morphology is common during sexual activity. Surgical correction of cam morphology significantly reduces the rate of impingement. Although this laboratory imaging-only study did not account for patient symptoms, this likely translates to significant symptomatic improvement during sexual activity after surgical cam correction.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Thomas R Yetter
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Hannah Morehouse
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Domenica Delgado
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Shane J Nho
- Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
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Nakano N, Audenaert E, Ranawat A, Khanduja V. Review: Current concepts in computer-assisted hip arthroscopy. Int J Med Robot 2018; 14:e1929. [DOI: 10.1002/rcs.1929] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/13/2018] [Accepted: 05/13/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Naoki Nakano
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Emmanuel Audenaert
- Department of Orthopaedic Surgery and Traumatology; Ghent University Hospital; Ghent Belgium
| | - Anil Ranawat
- Department of Orthopaedics, Hospital for Special Surgery; New York USA
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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