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Hohmann E. Editorial Commentary: Hip Arthroscopy Benefits Patients With Tönnis Grade 0 or 1 Hip Arthritis and Is Not Recommended for Grade 3: Optimal Treatment of Femoroacetabular Impingement Syndrome for Grade 2 Arthritis May Be Determined by Age and Body Mass Index. Arthroscopy 2024; 40:2039-2041. [PMID: 38365123 DOI: 10.1016/j.arthro.2024.02.010] [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: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
Femoroacetabular impingement syndrome (FAIS) is a possible cause of early osteoarthritis, and restoration of normal anatomy can potentially prevent future major cartilage damage. Symptomatic cam lesions can lead to debonding of articular cartilage, resulting in superolateral cartilage lesions in 93% of patients. Patients with pincer lesions often exhibit cartilage lesions in the anterior and superolateral glenoid rim. Whereas the efficacy of prophylactic surgery remains uncertain, surgical intervention appears to yield superior short-term clinical outcomes compared with conservative treatment. Yet, there is a relatively high prevalence of asymptomatic individuals in the general population with either cam (25%) or pincer (67%) deformities, so prophylactic treatment of asymptomatic patients cannot be recommended. Symptomatic FAIS patients with Tönnis grades 0 and 1 (minimal hip arthritis) benefit from hip arthroscopy. Patients with higher grades of osteoarthritis may be unsuitable hip arthroscopy candidates and face a higher risk of conversion to hip replacement. The existing evidence regarding the treatment of patients with FAIS and Tönnis grade 2 or higher remains inconclusive. Generally, surgery tends to have favorable outcomes for younger patients with a normal body mass index, whereas nonsurgical alternatives should be explored in cases with severe joint space narrowing, Tönnis grade 3, and bilateral cartilage lesions.
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González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [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: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
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Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
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Servant G, Bothorel H, Pernoud A, Fourchet F, Christofilopoulos P. Hip Arthroscopy Followed by 6-Month Rehabilitation Leads to Improved Periarticular Muscle Strength, Except for Abductors and External Rotators. Arthrosc Sports Med Rehabil 2024; 6:100900. [PMID: 38379599 PMCID: PMC10878845 DOI: 10.1016/j.asmr.2024.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To evaluate the variations in hip muscles strength following arthroscopy and 6-month rehabilitation in patients treated for femoroacetabular impingement (FAI). Methods A retrospective analysis was carried out on a series of patients who were arthroscopically treated for FAI at La Tour Hospital between 2020 and 2022. Bilateral isometric strengths of 8 hip-related muscles (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal and external rotators) were assessed using a handheld dynamometer before surgery and postoperatively after 6 months of rehabilitation in terms of relative strength changes between time points. Results A total of 29 patients (aged 26.9 ± 7.1 years, 86% of women) were included. Except for the abductors, which remained of comparable strength than before surgery, a statistically significant (P < .05) increase in hip muscle strength on the operated side could be noted at 6 postoperative months for hamstrings (9% ± 17%, P = .041), quadriceps (11% ± 27%, P = .045), extensors (17% ± 32%, P = .006), flexors (17% ± 29%, P = .003), adductors (18% ± 23%, P < .001), and internal rotators (32% ± 36%, P < .001). The proportion of patients who reached a strength level above their preoperative status ranged from 62% (quadriceps) to 86% (adductors and flexors), depending on the muscle studied. The external rotators were the only muscles that remained significantly weakened at 6 months on both operated (-13% ± 26%, P = .002) and nonoperated (-17% ± 25%, P < .001) sides, with a decrease beyond 15% in almost half of the patients (45% and 48%, respectively). Conclusions Arthroscopic treatment followed by 6-month rehabilitation granted to most FAI patients a higher strength level for several hip muscles, except for abductors and external rotators, which remained comparable and weakened, respectively. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Guillaume Servant
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | | | - François Fourchet
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
- French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
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Savage-Elliott I, Shankar DS, Li ZI, Moore M, Vasavada KD, Akpinar B, Youm T. Global Acetabular Retroversion Is Not Associated With Differences in Outcomes After Primary Hip Arthroscopy Among Patients With Femoroacetabular Impingement Syndrome: A Matched Cohort Study With Minimum 5-Year Follow-Up. Arthroscopy 2024; 40:820-827. [PMID: 37579957 DOI: 10.1016/j.arthro.2023.08.005] [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: 03/29/2023] [Revised: 07/10/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To compare hip survivorship and patient-reported outcome measures (PROMs) after primary hip arthroscopy at 5-year follow-up between patients with femoroacetabular impingement syndrome (FAIS) with radiographic signs of global acetabular retroversion and those without. METHODS A retrospective matched-cohort study was conducted using a single-surgeon hip arthroscopy database. Patients were included if they underwent primary hip arthroscopy for treatment of FAIS, had preoperative hip x-rays, and had a minimum 5-year follow-up. Global retroversion was defined as the presence of ischial spine sign, posterior wall sign, and crossover sign on anteroposterior view. Patients with FAIS with global retroversion were matched 1:1 on age, sex, and body mass index to FAIS controls. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were administered preoperatively and at follow-up. Hip survivorship and PROMs were compared between the 2 groups using the paired t test, Wilcoxon signed rank test, and/or Cochran-Mantel-Haenszel test as appropriate. P values <.05 were considered significant. RESULTS Thirty-eight patients with global retroversion (mean age 40.6 ± 10.8 years, 60.5% female) were matched to 38 controls (mean age 41.3 ± 13.6 years, 60.5% female). Reoperation rates were the same in both groups (5.3%). On average, both groups reported significant pre- to postoperative improvement in mHHS (P < .001) and NAHS (P < .001), and there was no significant intergroup differences in the change in mHHS (P = .86) or NAHS (P = .90). Achievement rates for the patient acceptable symptom state on the mHHS were higher among males compared to females (P = .04) in both the global retroversion group (93.3% vs 73.9%) and the control group (93.3% vs 73.9%). CONCLUSIONS Patients with FAIS with and without global acetabular retroversion had no significant difference in outcomes after primary hip arthroscopy at a minimum 5-year minimum follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Ian Savage-Elliott
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael Moore
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kinjal D Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
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Itha R, Vaishya R, Vaish A, Migliorini F. Management of chondral and osteochondral lesions of the hip : A comprehensive review. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:23-38. [PMID: 37815635 PMCID: PMC10781822 DOI: 10.1007/s00132-023-04444-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
Chondral and osteochondral lesions encompass several acute or chronic defects of the articular cartilage and/or subchondral bone. These lesions can result from several different diseases and injuries, including osteochondritis dissecans, osteochondral defects, osteochondral fractures, subchondral bone osteonecrosis, and insufficiency fractures. As the cartilage has a low capacity for regeneration and self-repair, these lesions can progress to osteoarthritis. This study provides a comprehensive overview of the subject matter that it covers. PubMed, Scopus and Google Scholar were accessed using the following keywords: "chondral lesions/defects of the femoral head", "chondral/cartilage lesions/defects of the acetabulum", "chondral/cartilage lesions/defects of the hip", "osteochondral lesions of the femoral head", "osteochondral lesions of the acetabulum", "osteochondral lesions of the hip", "osteochondritis dissecans," "early osteoarthritis of the hip," and "early stage avascular necrosis". Hip osteochondral injuries can cause significant damage to the articular surface and diminish the quality of life. It can be difficult to treat such injuries, especially in patients who are young and active. Several methods are used to treat chondral and osteochondral injuries of the hip, such as mesenchymal stem cells and cell-based treatment, surgical repair, and microfractures. Realignment of bony anatomy may also be necessary for optimal outcomes. Despite several treatments being successful, there is a lack of head-to-head comparisons and large sample size studies in the current literature. Additional research will be required to provide appropriate clinical recommendations for treating chondral/osteochondral injuries of the hip joint.
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Affiliation(s)
- Rajesh Itha
- Department of Orthopaedics, ESIC Model Hospital, 201307, Noida, Uttar Pradesh, India
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospital, Sarita Vihar, 110076, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospital, Sarita Vihar, 110076, New Delhi, India
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Center of Aachen, 52064, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
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Alito A, Fenga D, Tropeano G, Milardi D, Leonetti D, Migliorato A, Tisano A, D’Andrea D, Filardi V. Screw Stress Distribution in a Clavicle Fracture with Plate Fixation: A Finite Element Analysis. Bioengineering (Basel) 2023; 10:1402. [PMID: 38135993 PMCID: PMC10740883 DOI: 10.3390/bioengineering10121402] [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: 09/26/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Clavicle midshaft fractures are mostly treated surgically by open internal reduction with a superior or anteroinferior plate and screws or by intramedullary nailing. Screw positioning plays a critical role in determining the stress distribution. There is a lack of data on the screw position and the appropriate number of cortices required for plate fixation. The aim of this study is to evaluate the mechanical behavior of an anterior plate implanted in a fractured bone subjected to 120° of lateral elevation compared to a healthy clavicle using numerical simulations. Contact forces and moments used were obtained from literature data and applied to the healthy and fractured finite element models. Stresses of about 9 MPa were found on the healthy clavicle, while values of about 15 MPa were calculated on the plate of the fractured one; these stress peaks were reached at about 30° and 70° of elevation when the stress shielding on the clavicle sums all the three components of the solicitation: compression, flexion, and torsion. The stress distribution in a clavicle fracture stabilized with plates and screws is influenced by several factors, including the plate's position and design, the type of screw, and the biomechanical forces applied during movements.
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy;
| | - Giada Tropeano
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Demetrio Milardi
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Danilo Leonetti
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Alba Migliorato
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Danilo D’Andrea
- Department of Engineering, University of Messina, 98158 Messina, Italy;
| | - Vincenzo Filardi
- D.A. Scientific Research and Internationalization, University of Messina, 98121 Messina, Italy
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Centemeri R, Riva MA, Belingheri M, Paladino ME, D’Orso MI, Intra J. The Evaluation of the Balance Test and MuscleLab Test for the Early Detection of Femoroacetabular Impingement. J Funct Morphol Kinesiol 2023; 8:159. [PMID: 37987495 PMCID: PMC10660461 DOI: 10.3390/jfmk8040159] [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: 09/14/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Femoroacetabular impingement (FAI) is a common source of hip pain affecting a wide range of subjects. In this work, we assessed two tests, namely the balance test and the MuscleLab test, in comparison with the flexion-abduction-external rotation (FABER) and flexion-adduction-internal rotation (FADIR) tests, in order to evaluate the functionality of the neural-musculoskeletal system of the subjects affected by FAI based on the measurement of biomechanical parameters. Our goal was to investigate the early detection of an altered hip joint and to monitor pathology progression over time. A total of 52 subjects, 29 females and 23 males, with an average age of 42 ± 13 years presenting hip impingement diagnosed using X-ray, were enrolled. Twenty-eight patients without signs of hip impingements were used as the control group. The balance test, which evaluates the capacity of a person to keep the orthostatic position against terrestrial gravity, and the MuscleLab test, which measures the force and power generated by active muscles during a movement, as well as FABER and FADIR tests, were performed in each subject. The balance and MuscleLab tests presented 100% sensitivity and higher sensitivity in FAI diagnosis, with 72.9% and 70.4%, respectively, in comparison with those obtained using FABER and FADIR tests, with 59.6% and 67.3%, respectively. The evaluation of the neural-musculoskeletal system using the balance and MuscleLab tests can help in the early detection of the severity of hip impingements and the assessment of non-operative treatments used over time.
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Affiliation(s)
- Roberto Centemeri
- Department of Occupational Health, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (R.C.); (M.A.R.); (M.B.); (M.E.P.); (M.I.D.)
| | - Michele Augusto Riva
- Department of Occupational Health, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (R.C.); (M.A.R.); (M.B.); (M.E.P.); (M.I.D.)
| | - Michael Belingheri
- Department of Occupational Health, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (R.C.); (M.A.R.); (M.B.); (M.E.P.); (M.I.D.)
| | - Maria Emilia Paladino
- Department of Occupational Health, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (R.C.); (M.A.R.); (M.B.); (M.E.P.); (M.I.D.)
| | - Marco Italo D’Orso
- Department of Occupational Health, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (R.C.); (M.A.R.); (M.B.); (M.E.P.); (M.I.D.)
| | - Jari Intra
- Clinical Chemistry Laboratory, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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Pasculli RM, Callahan EA, Wu J, Edralin N, Berrigan WA. Non-operative Management and Outcomes of Femoroacetabular Impingement Syndrome. Curr Rev Musculoskelet Med 2023; 16:501-513. [PMID: 37650998 PMCID: PMC10587039 DOI: 10.1007/s12178-023-09863-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To serve as a guide for non-operative physicians in the management of femoroacetabular impingement syndrome and provide an algorithm as to when to refer patients for potential surgical management. RECENT FINDINGS Supervised physical therapy programs that focus on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core-focused programs. There is promising evidence for the use of intra-articular hyaluronic acid and PRP as adjunct treatment options. Recent systematic reviews and meta-analyses have found that in young active patients, hip arthroscopy demonstrates improved short-term outcomes over physical therapy. The decision for the management of FAIS is complex and should be specific to each patient. Consideration of the patient's age, timing to return to sport, longevity of treatment, hip morphology, and degree of cartilage degeneration is required to make an informed decision in the treatment of these patients.
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Affiliation(s)
- Rosa M. Pasculli
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA USA
| | - Elizabeth A. Callahan
- Department of Physical Medicine and Rehabilitation, New York University, New York, NY USA
| | - James Wu
- University of California Berkeley, Berkeley, CA USA
| | - Niam Edralin
- University of California Berkeley, Berkeley, CA USA
| | - William A. Berrigan
- Department of Orthopaedics, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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