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Spencer-Gardner L, Nunley B, Gómez-Hoyos J, Wells J, Khoury AN. Sagittal Pelvic Tilt Directly Influences the Ischiofemoral Space: A Cadaveric Study. Orthopedics 2024; 47:167-171. [PMID: 38285553 DOI: 10.3928/01477447-20240122-03] [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] [Indexed: 01/31/2024]
Abstract
BACKGROUND Ischiofemoral impingement (IFI) is understood to be a pain generator in the deep gluteal space. Femoral position is known to influence the ischiofemoral space (IFS), but there has been no study examining the effect of sagittal pelvic tilt on the IFS. The purpose of this study was to determine whether changes in pelvic tilt in the sagittal plane lead to changes in the dimensions of the IFS. MATERIALS AND METHODS Five fresh frozen cadavers (10 hips) were used for this anatomic study. The specimens were skeletonized and placed in the prone position with the pelvis fixed to a custom-built hinged table. A digital inclinometer was used to tilt the pelvis -10°, 0°, and 10° simulating posterior, neutral, and anterior pelvic tilt, respectively. Digital calipers were used to measure the dimensions of the IFS in all three positions of sagittal pelvic tilt. RESULTS Changes in pelvic tilt resulted in significant changes in the dimensions of the IFS. Mean IFS dimensions measured 29.3±9.7 mm, 37.2±9.0 mm, and 24.3±9.2 mm in the neutral, anterior, and posterior pelvic tilt positions, respectively (P<.0001). CONCLUSION Changes in sagittal pelvic tilt influence the dimensions of the IFS, with posterior pelvic tilt noted to significantly decrease the IFS when compared with neutral and anterior pelvic tilt. These findings suggest that further evaluation of sagittal spinopelvic balance in the etiology of symptomatic IFI may be warranted. [Orthopedics. 2024;47(3):167-171.].
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Flury A, Hoch A, Hodel S, Imhoff FB, Fucentese SF, Zingg PO. No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:414-423. [PMID: 35031820 DOI: 10.1007/s00167-021-06843-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting. METHODS Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The influence of morphologic factors of the femur [centrum-collum-diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated. RESULTS Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10-17°). In the frontal plane, mLDFA changed a mean of 0.1° (- 0.06 to 0.3°) (n.s.) and - 0.3° (- 0.5 to - 0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°-23°). mLDFA changed a mean of - 0.2° (- 0.5° to 0.2°) (p < 0.006) and 0.2° (0-0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (- 2.3 to 1.3) (p < 0.01) and 0.5° (- 1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to influence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5 mm in both the frontal and sagittal plane (p < 0.001). CONCLUSIONS In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Huang Y, Zeng Z, Xu LY, Li Y, Peng JP, Shen C, Zheng G, Chen XD. What Factors Are Associated With Postoperative Ischiofemoral Impingement After Bernese Periacetabular Osteotomy in Developmental Dysplasia of the Hip? Clin Orthop Relat Res 2022; 480:1694-1703. [PMID: 35384868 PMCID: PMC9384945 DOI: 10.1097/corr.0000000000002199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/11/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Any abnormal structures that contribute to the narrowing of the ischiofemoral space could induce ischiofemoral impingement. Bernese periacetabular osteotomy (PAO) medializes the hip center and, therefore, decreases contact stress on the cartilage in developmental dysplasia of the hip (DDH). However, medialization of the hip center might also narrow the ischiofemoral space, which may increase the risk of postoperative ischiofemoral impingement in patients with acetabular dysplasia who are undergoing PAO. Furthermore, the dysplastic hip has less ischiofemoral space and less space for the quadratus femoris. A few studies have focused on the amount of medialization of the hip center, but the proportion of postoperative ischiofemoral impingement after PAO has not been investigated. QUESTIONS/PURPOSES (1) What proportion of patients develop ischiofemoral impingement after undergoing unilateral PAO for DDH? (2) What radiographic factors are associated with postoperative ischiofemoral impingement in patients who underwent PAO for DDH? (3) How much hip center medialization is safe so as to avoid postoperative ischiofemoral impingement during PAO? METHODS Between 2014 and 2016, we treated 265 adult patients who had symptomatic residual acetabular dysplasia (lateral center-edge angle less than 20°) using PAO. During that time, we generally offered PAO to patients with acetabular dysplasia when the patients had no advanced osteoarthritis (Tönnis grade < 2). Of those, we considered only patients who underwent primary PAO without femoral osteotomy as potentially eligible. Based on that, 65% (173 of 265) were eligible; a further 9% (24 of 265) were excluded due to leg length discrepancy, spine disorders, or joint replacement in the contralateral side, and another 6% (17 of 265) of patients were lost before the minimum study follow-up of 2 years or had incomplete datasets, leaving 50% (132 of 265) for analysis in this retrospective study at a mean of 2.70 ± 0.71 years. The diagnosis of ischiofemoral impingement was defined by symptoms, MRI, and diagnostic ischiofemoral injection. We ascertained the percentage of patients with this diagnosis to answer the first research question. To answer the second question, we divided the patients into two groups: PAO patients with ischiofemoral impingement and PAO patients without ischiofemoral impingement. The demographic data and preoperative imaging parameters of patients in both groups were compared. There were statistical differences in acetabular version, ischial angle, neck-shaft angle, the presence of positive coxa profunda sign, McKibbin index, ischiofemoral space, quadratus femoris space, anterior acetabular section angle, and the net amount of hip center medialization. To investigate potential factors associated with postoperative ischiofemoral impingement in patients who underwent PAO, these factors underwent binary logistic regression analysis. To answer the third question, the cutoff value of the net amount of hip center medialization was evaluated using receiver operator characteristic curve and the Youden index method. RESULTS We found that 26% (35 of 132) of PAO dysplastic hips had postoperative ischiofemoral impingement. After controlling for confounding variables such as acetabular version, ischial angle, femoral neck version, McKibbin index, and ischiofemoral space, we found that an increasing neck-shaft angle (odds ratio 1.14 [95% confidence interval 1.01 to 1.29]; p = 0.03), a positive coxa profunda sign (OR 0.13 [95% CI 0.03 to 0.58]; p < 0.01), and an increasing net amount of hip center medialization (OR 2.76 [95% CI 1.70 to 4.47]; p < 0.01) were associated with postoperative ischiofemoral impingement in patients with DDH who underwent PAO (R 2 = 0.73). The cutoff values of neck-shaft angle was 138.4°. The cutoff values of the net amount of hip center medialization was 1.9 mm. CONCLUSIONS Postoperative ischiofemoral impingement could occur in patients with acetabular dysplasia who have undergone PAO after hip center medialization. An increasing neck-shaft angle, a positive coxa profunda sign on preoperative imaging, and excessive medialization of the hip center are factors associated with ischiofemoral impingement development in these patients. Therefore, we suggest that physicians measure the ischiofemoral space on a preoperative CT when patients with DDH have an increasing neck-shaft angle (> 138.4°) or a positive coxa profunda sign on radiological imaging. During PAO, the amount of hip center medialization should be carefully controlled to keep these patients from developing postoperative ischiofemoral impingement. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ying Huang
- Department of Anaesthesia, Xinhua Hospital, an affiliate of Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zheng Zeng
- Department of Orthopedics, The People's Hospital of Chengmai County, Hainan Province, China
| | - Liu-yang Xu
- Department of Orthopedics, Xin-hua Hospital, an affiliate of with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yang Li
- Department of Orthopedics, Xin-hua Hospital, an affiliate of with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jian-ping Peng
- Department of Orthopedics, Xin-hua Hospital, an affiliate of with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chao Shen
- Department of Orthopedics, Xin-hua Hospital, an affiliate of with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Guoyan Zheng
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-dong Chen
- Department of Orthopedics, Xin-hua Hospital, an affiliate of with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Flury A, Aregger F, Rahm S, Hoch A, Zingg PO. Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers. Hip Int 2022; 33:525-532. [PMID: 35067083 PMCID: PMC10170563 DOI: 10.1177/11207000211071046] [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: 02/04/2023]
Abstract
AIM The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. MATERIALS AND METHODS Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. RESULTS With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). CONCLUSIONS Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.
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Affiliation(s)
- Andreas Flury
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Fabian Aregger
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | | | - Armando Hoch
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Patrick O Zingg
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
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Rigling D, Zingg PO, Dora C. Subtrochanteric rotational osteotomy for young adults with hip pain due to femoral maltorsion. Hip Int 2021; 31:797-803. [PMID: 32750252 DOI: 10.1177/1120700020943811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Femoral rotational osteotomies can be a treatment option for symptomatic femoral maltorsion. This study investigated the clinical and radiological results of subtrochanteric rotational osteotomy and its potential adverse effects, particularly on patellofemoral stability and geometry. METHODS Retrospective consecutive series of patients undergoing subtrochanteric rotational osteotomy with hip arthroscopy. 25 hips, 18 with decreased (⩽4°), 7 with increased (⩾28°) femoral torsion (FT), were analysed. Mean follow-up was 37 months. Subjective Hip value (SHV), WOMAC and Harris Hip Score (HHS), hip range of motion, asymmetries in foot position during gait as well as patellofemoral instability were the outcome measures. Femoral and tibial torsion as well as morphological signs of patella maltracking (TTTG, patellar tilt and lateralisation) were measured on MRI. RESULTS SHV improved from 52% to 72% (p = 0.002), WOMAC from 3 to 1 (p < 0.001) and HHS from 68 to 86 (p < 0.001). Hips treated for reduced FT showed better internal rotation and hips treated for excessive FT less internal rotation compared to the opposite side. 1 patient demonstrated asymptomatic minor in-toeing. Objective patellofemoral instability was not found except for in 1 patient with bilateral patellofemoral apprehension. FT was normalised (mean 16° ± 9°). Tibial torsion showed normal values. Compared to the opposite side TTTG (p > 0.08), patellar tilt (p > 0.09) and lateralisation (p > 0.26) did not differ. No complications occurred. CONCLUSIONS Subtrochanteric rotational osteotomy with hip arthroscopy improves the hip subjectively without leading to objective patellofemoral instability nor changes in the patellofemoral geometry compared to contralateral side. The technique of subtrochanteric rotational osteotomy is safe and reliable.
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Affiliation(s)
- Dominic Rigling
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Roth T, Rahm S, Jungwirth-Weinberger A, Süess J, Sutter R, Schellenberg F, Taylor WR, Snedeker JG, Widmer J, Zingg P. Restoring range of motion in reduced acetabular version by increasing femoral antetorsion - What about joint load? Clin Biomech (Bristol, Avon) 2021; 87:105409. [PMID: 34144389 DOI: 10.1016/j.clinbiomech.2021.105409] [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: 10/22/2020] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular retroversion results in reduced range of motion, and is thought to contribute to femoroacetabular impingement. Severe retroversion can be corrected with a periacetabular osteotomy, which is a technically demanding intervention. In this study, we investigated whether increasing femoral antetorsion is a potential alternative to restore the range of motion and how this approach would affect hip joint loading. METHODS Six different finite element models of the same subject were built from MRI and used to simulate different load scenarios during stance phase, including healthy and pathological configurations with different acetabular version and femoral torsion angles. The subject's gait was analysed in our gait lab and motion data as well as joint reaction forces were integrated into the model. Hip range of motion, hip abductor muscle forces as well as localization and magnitude of hip joint loads were determined. FINDINGS The negative effects of acetabular retroversion on hip range of motion including flexion and internal rotation can be reversed by increasing femoral anteversion. The rotation of the femur furthermore affected muscular functionality by shortening the moment arms of the hip abductor muscles, resulting in increased abductor muscle forces, joint reaction forces and hip joint loading. INTERPRETATION Even though increased femoral antetorsion can compensate for the loss of hip range of motion due to reduced acetabular version, rotational ostotomy of the proximal femur is likely to alter muscular moment arms and therefore increase hip joint load, conflicting the goal of a long-term healthy joint.
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Affiliation(s)
- Tabitha Roth
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Anna Jungwirth-Weinberger
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Janine Süess
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Reto Sutter
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Florian Schellenberg
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland.
| | - William R Taylor
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland.
| | - Jess G Snedeker
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Jonas Widmer
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Patrick Zingg
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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Vera AM, Nho SJ, Mather Iii RC, Wuerz TH, Harris JD. Hip Instability in Ballet Dancers: A Narrative Review. J Dance Med Sci 2021; 25:176-190. [PMID: 34082862 DOI: 10.12678/1089-313x.091521c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Dancers possess a large degree of hip range of motion that results from a combination of innate and acquired osseous morphology and permissive soft tissues. Generalized hypermobility in dancers may predispose them to a spectrum of hip instability. The objective of this narrative review is to discuss the anatomical characteristics, pathogenesis, risk factors, clinical signs and symptoms, management, and outcomes of hip instability treatments in dancers. METHODS A retrospective search was performed beginning November 1, 2017, for English language articles regarding hip stability in the dancer. Key words used included but were not limited to: dance(r), ballet, hip, hypermobility, range of motion, instability, microinstability, and laxity. PubMed, Scopus, and MEDLINE databases were used. RESULTS Forty-three studies were analyzed. Groin pain was found to be the most common presenting symptom of hip instability. A variety of impingement and instability signs may be elicited during physical examination. Hypermobility is frequently observed and is thought to be a necessity for participation in elite levels of ballet. Radiographs and advanced planar imaging (magnetic resonance imaging and computed tomography) should be scrutinized to evaluate for dysplasia, cam, pincer, subspine, and rotational morphologies. Dysplasia (low volume acetabulum), cam morphology, femoral retroversion, and coxa valga are common findings in the ballet dancers' hip. Labral injuries and ligamentum teres tears are common and may potentiate instability in the hip. Management options include education, oral non-opioid medications, activity modification, exercise prescription, and surgery. Reported outcomes of these treatments in ballet are limited. CONCLUSION Hip hypermobility is prevalent in the ballet population and is a clear advantage. However, it may increase the risk of instability. It is important to identify the multifactorial osseous and soft tissue etiology of hip or groin pain in dancers. Practitioners should have a high level of suspicion for hip instability in the dancer presenting with hip pain and treat accordingly. There is a significant need for increased quantity and quality of investigation into the outcomes of treatment for hip instability in the dancer.
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Ahmad SS, Kerber V, Konrads C, Ateschrang A, Hirschmann MT, Stöckle U, Ahrend MD. The ischiofemoral space of the hip is influenced by the frontal knee alignment. Knee Surg Sports Traumatol Arthrosc 2021; 29:2446-2452. [PMID: 33950346 PMCID: PMC8298225 DOI: 10.1007/s00167-021-06589-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/21/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The ischiofemoral distance (IFD), defined as the distance between the ischial tuberosity and the lesser trochanter of the femur, is gaining recognition as an extra-articular cause of hip pain. It is unknown whether the IFD is influenced by the frontal knee alignment. The aim of this study was to determine the influence of realignment surgery around the knee on the IFD. It was hypothesized that valgisation osteotomy around the knee is associated with reduction of the IFD. METHODS A consecutive series of 154 patients undergoing frontal realignment procedures around the knee in 2017 were included in this study. Long-leg standing radiographs were obtained before surgery and postoperatively. The IFD was measured between the ischium and the lesser trochanter at three different levels (proximal, middle and distal margins of the lesser trochanter parallel to the horizontal orientation of the pelvis) on standardized long-leg radiographs with the patient in upright standing position. The knee alignment was determined by measuring the hip knee ankle angle, mechanical lateral distal femur angle and the medial mechanical proximal tibia angle. Linear regression was performed to determine the influence of the change of frontal knee alignment on the IFD. RESULTS Linear regression showed a direct influence of the overall change in frontal knee alignment on the IFD of the hip, regardless of the site of the osteotomy (β-0.4, confidence-interval - 0.5 to - 0.3, p < 0.001). Valgisation osteotomy around the knee induced a significant reduction of the ipsilateral IFD (p < 0.001), while varisation osteotomy induced a significant increase (p < 0.001). The amount of ISD change was 0.4 mm per corresponding degree of change in frontal knee alignment. CONCLUSION These findings are relevant to both the hip and knee surgeons when planning an osteotomy or arthroplasty procedure. Correction of a malalignment of the knee may resolve an ischiofemoral conflict in the hip. The concept deserves inclusion in the diagnostic workup of both the hip and knee joints. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sufian S. Ahmad
- grid.10392.390000 0001 2190 1447BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany ,grid.6363.00000 0001 2218 4662Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vincent Kerber
- grid.10392.390000 0001 2190 1447BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Christian Konrads
- grid.10392.390000 0001 2190 1447BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Atesch Ateschrang
- grid.502406.5Evangelisches Stift St. Martin Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Michael T. Hirschmann
- grid.440128.b0000 0004 0457 2129Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland
| | - Ulrich Stöckle
- grid.6363.00000 0001 2218 4662Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc D. Ahrend
- grid.10392.390000 0001 2190 1447BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
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Radiologic Correlation Between the Ischiofemoral Space and Morphologic Characteristics of the Hip in Hips With Symptoms of Dysplasia. AJR Am J Roentgenol 2018; 210:608-614. [DOI: 10.2214/ajr.17.18465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Short-term outcomes of open hip preservation surgery for symptomatic extraarticular femoroacetabular impingement. Hip Int 2017; 27:599-607. [PMID: 28605002 DOI: 10.5301/hipint.5000506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purposes of this study were to describe: (i) short-term disease-specific patient-reported outcome scores (PROMs); and (ii) factors associated with reoperation or treatment failure in patients undergoing open hip preservation surgery for symptomatic extraarticular FAI. METHODS Patients undergoing open hip preservation surgery for symptomatic extraarticular FAI were identified from a prospective, single-centre hip preservation registry (n = 51 patients; median clinical follow-up 24 [range 11-49] months). Hip-specific PROMs were assessed preoperatively, 6 months, and each year subsequently. Patients undergoing reoperation or treatment failure (<10 point improvement in iHOT-33 postoperatively) over the study period were identified. Preoperative associated factors were explored on a univariate basis. RESULTS International Hip Outcome Tool-33 (iHOT-33) improved from 33 (standard deviation [SD] 18) to 62 (26) at most recent follow-up and 76% of patients improved by minimum clinically important difference (MCID). Harris Hip Score improved from 53 (15) to 75 (17) at most recent follow-up and 79% of patients improved by MCID. Hip Outcome Score (HOS) Sport improved from 45 (26) to 66 (28) at most recent follow-up and 60% of patients improved by MCID. Continued improvements in mean follow-up scores were seen from 1 year to 2 years. Overall, 7 patients underwent reoperation and 9 patients failed to improve by MCID. Preoperative HOS Sport was higher in patients experiencing reoperation or treatment failure (58 [SD 19] vs. 40 [SD 27] respectively; p = 0.03). No other associated demographic, physical examination, or radiographic factors were found. CONCLUSIONS Open treatment of extraarticular FAI results in short-term improvements in hip-specific PROMs in most patients. Higher HOS Sport scores were associated with reoperation or treatment failure. Longer-term follow-up is necessary to define maximum improvements in this challenging patient population.
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Lee CB, Spencer HT. Comparison of Intraoperative Fluoroscopic Dunn View With Magnetic Resonance Imaging to Determine Femoral Version. Arthroscopy 2017; 33:1186-1193. [PMID: 28302428 DOI: 10.1016/j.arthro.2017.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/06/2016] [Accepted: 01/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare femoral version measured with a fluoroscopic Dunn view taken at the time of hip arthroscopy with values derived from axial magnetic resonance imaging (MRI) scans. METHODS Of 159 hip arthroscopies performed from January 2014 through March 2015, 50 patients had magnetic resonance imaging (MRI) scans with a protocol that incorporates femoral version analysis. Dunn views are performed as a routine part of the preoperative fluoroscopic examination at the time of arthroscopy. Femoral version was measured from the fluoroscopic views and compared with values calculated from axial MRI images. The measurements were compared with a paired t test for difference in means, the intraclass correlation coefficient (ICC) for reliability, and the limits of agreement method of Bland and Altman. RESULTS There was a very small but statistically significant difference between the measurement on fluoroscopic Dunn view and the value on axial MRI (mean difference, 1.4°, P = .03). The ICC was 0.809 (P < .0001), indicating substantial agreement. By the Bland and Altman method, the 95% limits of agreement for fluoroscopic versus MRI measurement were -7.6 to 10.4, with no significant difference in variance by Pitman test (P = .526). CONCLUSIONS With careful attention to technique, the fluoroscopically simulated Dunn view can be used to measure femoral version with acceptable accuracy and obviates the need for repeat 3-dimensional imaging for patients who already have an MRI scan without version analysis. LEVEL OF EVIDENCE Level II, testing of previously developed diagnostic criteria with a gold standard.
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Affiliation(s)
- Cara Beth Lee
- Center for Hip Preservation, Virginia Mason Medical Center, Seattle, Washington, U.S.A..
| | - Hillard T Spencer
- Orthopedics Department, Southern California Permanente Medical Group, Anaheim, California, U.S.A
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Dangin A, Tardy N, Wettstein M, May O, Bonin N. Microinstability of the hip: A review. Orthop Traumatol Surg Res 2016; 102:S301-S309. [PMID: 27744000 DOI: 10.1016/j.otsr.2016.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/20/2016] [Indexed: 02/02/2023]
Abstract
With the development of conservative hip surgery techniques, new entities such as microinstability have been identified. Microinstability is a painful supra-physiological mobility of the hip. It results from the association of architectural and functional abnormalities impairing joint stability. These risk factors concern hip joint bone architecture or peri-articular soft tissues. Bone abnormalities are identified on hip assessment parameters. Soft tissues also play a key role in the static and dynamic stability of the hip: the joint capsule, labrum, ligamentum teres and adjacent myotendinous structures affect joint coaptation; any abnormality or iatrogenic lesion concerning these structures may constitute a risk factor for microinstability. Diagnosis is based on interview, clinical examination and imaging. Findings of labral lesions or femoro-acetabular impingement do not rule out microinstability; they may be associated. Treatment is based first on physiotherapy for muscle reinforcement to improve joint coaptation. In case of failure, arthroscopic surgery is indicated for femoro-acetabular impingement and capsular plicature which is being evaluated. Periacetabular osteotomy or shelf acetabuloplasty may be indicated, according to the severity of joint bone architecture abnormality. Microinstability is a multifactorial entity. Lesions induced by microinstability may in turn become risk factors for aggravation. Diagnosis and indications for surgery are thus difficult to establish. Only full clinical examination and exhaustive imaging assessment allow microinstability and associated lesions to be identified.
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Affiliation(s)
- A Dangin
- CHU Nord Saint-Étienne, chirurgie orthopédique et de traumatologie, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - N Tardy
- Centre osteo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Echirolles, France.
| | - M Wettstein
- Chirurgie orthopédique et de traumatologie, institut de traumatologie et d'orthopédie du Léman, chemin des Allinges 10, 1006 Lausanne, Switzerland; Clinique de Genolier, route du Muids, 3, 1272 Genolier, Switzerland.
| | - O May
- Centre de chirurgie de la hanche, 45, rue de Gironis, 31100 Toulouse, France.
| | - N Bonin
- Lyon-Ortho-Clinic, 29B, avenue des Sources, 69009 Lyon, France.
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