Does psychological distress predict risk of orthopaedic surgery and postoperative opioid prescribing in patients with hip pain? A retrospective study

BACKGROUND

Clinicians and public health professionals have allocated resources to curb opioid over-prescription and address psychological needs among patients with musculoskeletal pain. However, associations between psychological distress, risk of surgery, and opioid prescribing among those with hip pathologies remain unclear.

METHODS

Using a retrospective cohort study design, we identified patients that were evaluated for hip pain from January 13, 2020 to October 27, 2021. Patients' surgical histories and postoperative opioid prescriptions were extracted via chart review. Risk of hip surgery within one year of evaluation was analyzed using multivariable logistic regression. Multivariable linear regression was employed to predict average morphine milligram equivalents (MME) per day of opioid prescriptions within the first 30 days after surgery. Candidate predictors included age, gender, race, ethnicity, employment, insurance type, hip function and quality of life on the International Hip Outcome Tool (iHOT-12), and psychological distress phenotype using the OSPRO Yellow Flag (OSPRO-YF) Assessment Tool.

RESULTS

Of the 672 patients, n = 350 (52.1%) underwent orthopaedic surgery for hip pain. In multivariable analysis, younger patients, those with TRICARE/other government insurance, and those with a high psychological distress phenotype had higher odds of surgery. After adding iHOT-12 scores, younger patients and lower iHOT-12 scores were associated with higher odds of surgery, while Black/African American patients had lower odds of surgery. In multivariable analysis of average MME, patients with periacetabular osteotomy (PAO) received opioid prescriptions with significantly higher average MME than those with other procedures, and surgery type was the only significant predictor. Post-hoc analysis excluding PAO found higher average MME for patients undergoing hip arthroscopy (compared to arthroplasty or other non-PAO procedures) and significantly lower average MME for patients with public insurance (Medicare/Medicaid) compared to those with private insurance. Among those only undergoing arthroscopy, older age and having public insurance were associated with opioid prescriptions with lower average MME. Neither iHOT-12 scores nor OSPRO-YF phenotype assignment were significant predictors of postoperative mean MME.

CONCLUSIONS

Psychological distress characteristics are modifiable targets for rehabilitation programs, but their use as prognostic factors for risk of orthopaedic surgery and opioid prescribing in patients with hip pain appears limited when considered alongside other commonly collected clinical information such as age, insurance, type of surgery pursued, and iHOT-12 scores.

Can intra-articular hip injections predict arthroscopy outcomes for femoroacetabular impingement syndrome? A systematic review

Background

Femoroacetabular Impingement (FAI) syndrome represents a prevalent aetiology of hip discomfort observed among both adolescent and adult populations. It is initially managed conservatively with oral anti-inflammatories and physiotherapy; some patients proceed to receiving an intra-articular (IA) hip injection, but ultimately, the gold-standard treatment is hip arthroscopy.

Study design

Systematic Review.

Purpose

To systematically investigate the relationship between response to IA anaesthetic or steroid hip injections and arthroscopy outcomes for FAI syndrome.

Methods

A systematic search of PubMed, Medline, CINAHL, SCOPUS, and Cochrane was conducted in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.

Results

Seven studies (Level II-IV) were identified that met our inclusion and exclusion criteria. These studies collectively included 637 patients, demonstrating an average age of 37.5 years (and a range of 14-72 years). Two of the seven studies reported a statistically significant positive correlation between response to IA injections and arthroscopy outcomes. The remaining five studies found that although a positive IA injection response increased the odds of a good outcome post arthroscopy (defined across various studies as a post-operative modified Harris Hip score of >70 points, >79 points or an improvement by 8 or more points), this correlation was not statistically significant.

Conclusion

IA hip injections can be a useful prognostic tool, though they are not a consistently reliable predictor of which patients will have good arthroscopic outcomes.

Van Neck-Odelberg Disease: A Rare Cause of Pediatric Hip Pain

Introduction

Synchondrosis ischiopubic syndrome (SIS), also known as Van Neck-Odelberg disease, is a benign skeletal abnormality in children due to delayed closure in the ischiopubic synchondrosis (IPS). Patients may present with vague groin, hip, or buttock pain that can cause limitation of hip movement or limp. Few descriptions of this disorder exist, and it can easily be mistaken for other pathologies, including stress fracture, osteomyelitis, or tumor.

Case Report

We report the case of a 9-year-old female gymnast presenting with right hip pain who was diagnosed with SIS. She was managed conservatively by the pediatric orthopedist.

Conclusion

Van Neck-Odelberg disease is a rare cause of pediatric hip pain that can be mistaken for other more serious pathologies. The ability to recognize the disease early allows for effective treatment and the avoidance of unnecessary procedures.

Patient-reported hip pain and function are worse among elite Nordic ski athletes competing in ski jumping versus Nordic combined: a cross-sectional analysis

OBJECTIVES

Nordic ski athletes are at increased risk of developing hip pain and dysfunction secondary to femoroacetabular impingement syndrome (FAIS), but it is unclear whether hip symptomatology differs between ski jumping (SJ) and Nordic combined (NC) athletes. The purpose of this study was to compare patient-reported hip pain and dysfunction between elite Nordic ski athletes participating in SJ versus NC.

METHODS

A cross-sectional study was conducted involving SJ and NC athletes who competed at the international and U.S. national levels during the 2021-2022 season. Subjects were excluded if they had hip surgery within two years prior to enrollment. Subjects were asked to undergo diagnostic workups for FAIS, including physical examination and plain radiographic imaging. Subjects were asked to complete a survey that collected information on athletic and training history and to complete the hip disability and osteoarthritis outcome score (HOOS). Demographics, athletic/training history, and HOOS sub-scores were compared between the SJ and NC groups using the Student's t-test, Wilcoxon rank-sum test, or Fisher's exact test, as appropriate. p-values < 0.05 were considered significant.

RESULTS

Twenty-four athletes (13 SJ, 11 NC) were included in the study. There were no statistically significant differences in age, sex, BMI, or age of menarche between the two groups (all p ​> ​0.05). There were also no statistically significant differences in the number of prior sports participated in, total hours of participation in prior sports, or total hours of training in Nordic specialization (all p ​> ​0.05). Among the 18 athletes who underwent physical examination (9 SJ, 9 NC), there were no statistically significant inter-group differences in hip range of motion or incidence of positive impingement tests (all p ​> ​0.05). Among the 19 athletes who underwent imaging (9 SJ, 10 NC), there were no statistically significant inter-group differences in the incidence of cam or pincer morphology in at least one hip (all p ​> ​0.05). SJ athletes had statistically significantly worse HOOS sub-scores for hip symptoms and stiffness, hip function in sports/recreational activities, and hip-related quality of life compared to NC athletes (all p ​< ​0.05).

CONCLUSION

Elite SJ athletes have worse self-reported hip function compared to elite NC athletes, despite comparable demographics, athletic history, and duration of ski training.

LEVEL OF EVIDENCE

IV.

Cross-cultural adaptation, validation and psychometric evaluation of the International Hip Outcome Tool 12 (iHOT12) to Hebrew

BACKGROUND

The "International Hip Outcome Tool 12" (iHOT12) is a self-administered patient-reported outcome tool for measuring health-related quality of life and physical functioning in young and active patients with hip pathology. Since the iHOT12 has become widely used, we sought to translate and validate it for Hebrew-speaking populations. The aims of this study were: (1) To translate and culturally adapt the iHOT12 into Hebrew using established guidelines. (2) To test the new Hebrew version for validity, and (3) reliability.

METHODS

The iHOT12 was translated and culturally adapted from English to Hebrew (iHOT12-H) according to the COSAMIN guidelines. For validity, the iHOT12-H and Western Ontario and McMaster universities osteoarthritis index (WOMAC) were completed by 200 patients with hip pathology. Exploratory factor analysis was used to assess structural validity. Subsequently, 51 patients repeated the iHOT12-H within a 2-week interval. Intraclass Correlation Coefficient (ICC), Cronbach alpha, and Standard Error of Measurement (SEM) were calculated to assess reliability.

RESULTS

Construct validity: iHOT12-H correlated strongly to the WOMAC scores (r = -0.82, P < 0.001, Spearman). Factor analysis revealed a two-factor structure. Cronbach's alpha was 0.953 confirming internal consistency to be highly satisfactory. Test-retest correlation of the iHOT12-H was excellent with an ICC = 0.956 (95% CI 0.924-0.974). There was no floor or ceiling effect.

CONCLUSION

The iHOT12 Hebrew version has excellent reliability, good construct validity and can be used as a measurement tool for physical functioning and quality of life in young, physically active patients with hip pathology. This study will serve Israeli researchers in evaluating treatment effectiveness for these patients. Moreover, it will also enable multinational cooperation in the study of hip pathology.

Importance of cytochrome 3A4 and 2D6-mediated drug-drug interactions in oxycodone consumption among older adults hospitalized for hip fracture: a cross-sectional study

Hip fracture is a common injury and represents a major health problem with an increasing incidence. In older adults, opioids such as oxycodone are often preferred to other analgesics such as tramadol because of a lower risk of delirium. Different parameters, such as inhibition of cytochrome P450 (CYP450) 2D6 and/or 3A4, can potentially lead to pharmacokinetic variations of oxycodone representing a risk of adverse drugs effects or lack of drug response. There is a risk of drug-drug interactions involving CYP450 in older adults due to the high prevalence of polypharmacy. This study sought to identify patient characteristics that influence oxycodone administration. A single-center observational study included 355 patients with a hip fracture hospitalized in a geriatric postoperative unit. Composite endpoint based on form, duration, and timing to intake separated patients into three groups: "no oxycodone", "low oxycodone ", and "high oxycodone ". CYP450 interactions were studied based on a composite variable defining the most involved CYP450 pathways between CYP2D6 and CYP3A4. CYP450 interactions with CYP2D6 pathway involved were associated with the risk of "high oxycodone" [odds ratio adjusted on age and the type of hip fracture (OR*) 4.52, 95% confidence interval (CI) 1.39-16.83, p = 0.02)], as well as serum albumin levels (OR* 1.09, 95% CI 1.02-1.17, p = 0.01). Cognitive impairment was negatively associated with the risk of "high oxycodone" (OR* 0.38, 95% CI 0.18-0.77, p = 0.02). This study showed an association between CYP2D6 interactions and higher oxycodone consumption indirectly reflecting the existence of uncontrolled postoperative pain.

The reliability and validity of the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian) for patients with greater trochanteric pain syndrome

BACKGROUND

Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting.

METHODS

This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses.

RESULTS

78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach`s alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and - 0.63 respectively.

CONCLUSION

The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922).

Case report: Incarcerated obturator hernia, initially presenting as right hip pain!

INTRODUCTION

An incarcerated Obturator herniation is a rare external abdominal hernia. Abdominal CT-scanning is the first choice for the diagnosis of such an incarcerated Obturator hernia. Since intestinal incarceration leads to acute necrosis. Therefore emergency surgical treatment is required. However, due to the lack of specificity of the clinical manifestations of incarcerated Obturator hernia, a delay in adequate diagnostics may be higher than expected.

PRESENTATION OF CASE

An 82 year woman was admitted to the hospital because of right hip joint pain. She was initially evaluated and admitted by orthopedics team for suspected arthritis. A CT-scan with contrast was ordered, which showed an intestinal ischemic obstruction in a right sided obturator hernia, an acute laparotomy was carried out.

DISCUSSION

This case is important and differs from the well-known similar cases through the emergency admission at the orthopedic department because of the clear right hip pain and clinical history from the patient. An Obturator herniation (OH) is a rare external abdominal hernia accounting for only 0.07 %-1 % of all hernia cases. Because the female pelvis is wider which can lead to herniation of abdominal contents. The Howship-Romberg sign should be checked during physical examination.

CONCLUSION

Obturator hernia is very rare and difficult to diagnose. Moreover when elderly women suffer from long-term chronic diseases, a very thin body, or a history of multiple deliveries. Howship-Romberg sign should be checked in these situations during physical examination. Early diagnosis and treatment significantly reduces the occurrence of intestinal perforation, necrosis, sepsis and/or other severe adverse events, thereby, a significant prognostic improvement of patients.

Intra-articular corticosteroids associated with increased risk of total hip arthroplasty at 5 years

BACKGROUND

Intra-articular corticosteroid injections are commonly administered for hip pain. However, guidelines are conflicting on their efficacy, particularly in patients without arthritis. This study assessed for an association of corticosteroid injections and the incidence of total hip arthroplasty at 5 years.

METHODS

Patients with a diagnosis of hip pain without femoroacetabular osteoarthritis who were administered an intra-articular corticosteroid injection of the hip within a 2-year period were identified from the Mariner PearlDiver database. Patient were matched to patients with a diagnosis of hip pain who did not receive an injection. 5-year incidence of total hip arthroplasty was compared between matched patients who received an intra-articular corticosteroid injection and those who did not.

RESULTS

2,540,154 patients diagnosed with hip pain without femoroacetabular arthritis were identified. 25,073 (0.9%) patients received a corticosteroid injection and were matched to an equal number of control patients. The incidence of total hip arthroplasty (THA) at 5-year-follow up was significantly higher for the corticosteroid cohort compared to controls (1.1% vs. 0.5%; p < 0.001). The incidence and risk of THA increased along with number of injections (1 injection: 0.8%, OR 1.37; 95% CI, 1.34-1.42; p < 0.001, 2 injections: 1.1%; OR 1.45; CI, 1.40-1.50; p < 0.001, ⩾3 injections: 1.5%; OR 1.48; CI, 1.40-1.56; p < 0.001).

CONCLUSIONS

There may be a dose-dependent association of corticosteroid injections and a greater risk of total hip arthroplasty at 5 years. These results along with the conflicting guidelines on the efficacy of intra-articular steroids for hip pain should prompt physicians to consider osteoarthritis progression that may occur in the setting of corticosteroid injections in non-arthritic hips.

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip

BACKGROUND

Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function.

METHODS

This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman's rank correlation coefficients. Statistical correlation strength was defined as low (r =  ± 0.1-0.3), moderate (r =  ± 0.3-0.5) and strong (r >  ± 0.5).

RESULTS

Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain.

CONCLUSION

Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

Late Presentation of Tricho-Rhino-Phalangeal Syndrome (TRPS1 Affected) Associated Hip Pathology

Perthes disease typically presents between the ages of 4 and 9 years and is characterized by unilateral or bilateral avascular necrosis of the femoral head. Clinically it presents with pain and decreased range of motion and has a disease course of up to 5 years. We report the clinical and radiological findings of a female in early adolescence who was referred to pediatric physiotherapy and found to have Perthes-like changes of the hip, on a background of tricho-rhino-phalangeal syndrome type 1 (TRPS1). The patient's first symptoms of hip pain were reported at age 10, but there was no radiographic evidence until 2.5 years later when a diagnosis of Perthe's disease was made. This uniquely late presentation may have been due to the altered skeletal maturation seen in TRPS1, whereby skeletal age lags behind chronological age. This case highlights the importance of identifying relevant past medical history on initial assessment, and having rapid access to radiology and orthopedic support to enable timely diagnosis, as prognosis becomes poorer as age increases. Perthes-like changes should be considered as a differential diagnosis in patients presenting with non-traumatic hip pain, regardless of age of onset.

Pericapsular Nerve Group Block as an Effective Intervention for Pain Relief and Improving Functional Mobility in Cancer Patients: A Case Series

Pericapsular nerve group block (PENG) is an ultrasound-guided regional block technique that blocks the articular branches of the femoral nerve, accessory obturator nerve and obturator nerve. These nerves richly innervate the anterior capsule of the hip joint and blocking these nerves helps in hip analgesia. PENG block is commonly used in hip fracture pain perioperatively. In this case series, we have used PENG block in cancer patients with hip pain. PENG block was given to six patients with bupivacaine and triamcinolone, out of which five patients had good pain relief and their functional mobility to activities of daily living improved.

Arthritis of the hip caused by arteriovenous malformations: A case report

BACKGROUND Arthritis of the hip caused by arteriovenous malformations (AVMs) has been rarely reported. Therefore, total hip replacement (THR) in patients with AVM-induced arthritis of the hip is challenging. CASE SUMMARY We report a 44-year-old woman with aggravated right hip pain during the past decade. The patient presented with severe pain and a functional disorder of the right hip. X-ray examination revealed severely narrowed right hip joint space and abnormal trabecular bone loss in the femoral neck and trochanter area. Doppler ultrasound, magnetic resonance imaging and computed tomography angiography revealed AVMs surrounding the right hip, along with erosion. To ensure the safety of THR, we performed vascular embolization and temporary balloon occlusion of the iliac artery three times during the operation. However, serious hemorrhage occurred, which was rescued by the multimodality blood conservation strategy. THR was successfully performed, and the patient was discharged 8 d later for rehabilitation. Postoperative pathological examination showed osteonecrosis of the femoral head with malformed thick-walled vessels and focal granulomatous inflammation of the surrounding soft tissues. The Harris Hip Scale score increased from 31 to 82 at 3 mo of follow-up. The patient was followed up for 1 year, and all her clinical symptoms were significantly alleviated. CONCLUSION Arthritis of the hip caused by AVMs is rare in clinical practice. The activity and function of the involved hip joint can be effectively treated with THR after comprehensive imaging and multidisciplinary consultation.

Diagnosing Hip Microinstability: an international consensus study using the Delphi methodology

PURPOSE

Hip microinstability is a relatively new diagnosis which is increasingly being discussed in the literature and yet there are no clear guidelines for making a diagnosis. Microinstability has generally been defined as persistent excessive hip motion that has become symptomatic especially with pain. This aim of this Delphi study was to seek expert opinion to formulate a diagnostic criteria for hip microinstability.

METHODS

A Delphi methodology was used for this consensus study. A literature search was conducted on PubMed up to March 2019 using the keywords ((hip) and (microinstability)) to identify relevant articles on this topic. All relevant criteria used for diagnosing hip microinstability were collated to create a questionnaire and further criterion suggested by the experts were included as well. Four rounds of questionnaires were delivered via an online survey platform. Between each round the authors acted as administrating intermediaries, providing the experts with a summary of results and synthesising the next questionnaire. The expert panel was comprised of 27 members: 24 (89%) orthopaedic surgeons and 3 (11%) physiotherapists from around the world.

RESULTS

Expert panel participation in rounds 1-4 was: 27 (100%), 20 (74%), 21 (78%) and 26 (96%) respectively. A literature review by the authors identified 32 diagnostic criteria to populate the first questionnaire. Experts suggested amending three criteria and creating five new criteria. The panel converged on ranking 3 (8%) of criteria as "Not important", 20 (54%) as "Minor Factors" and 14 (38%) as "Major Factors". No criteria was ranked as "Essential". Criteria were subcategorised into patient history, examination and imaging. Experts voted for a minimum requirement of four criteria in each subcategory, including at least six "Major factors". The final diagnostic tool was approved by 20 (77%) of the final round panel.

CONCLUSION

This study describes the first known expert consensus on diagnosing hip microinstability. The relative complexity of the final diagnostic tool is illustrative of the difficulty clinicians' face when making this diagnosis.

LEVEL OF EVIDENCE

V.

Differences in hip torque ratios between individuals with femoroacetabular impingement syndrome and asymptomatic individuals: A cross-sectional study

BACKGROUND

Hip torque ratios are considered a useful measure for patients with hip pain. However, evidence regarding this measure for patients with femoroacetabular impingement syndrome is scarce. The primary aim of this study was to compare hip external-internal rotation and abduction-adduction torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. The secondary aim was to compare hip torque ratios between the asymptomatic group and femoroacetabular impingement syndrome patients grouped according to the severity of symptoms and functional limitations.

METHODS

Hip abduction-adduction and external-internal rotation torque ratios of 134 individuals with femoroacetabular impingement syndrome and 134 asymptomatic matched controls was assessed through isokinetic testing. Severity of symptoms and functional limitations was assessed through the iHOT-33. Mann Whitney U and Kruskall-Wallis tests were used to compare hip torque ratios between asymptomatic individuals and patients with femoroacetabular impingement syndrome and to patients with femoroacetabular impingement syndrome with different severities of symptoms and functional limitations.

FINDINGS

No differences were identified in hip abduction-adduction (U = 7659.5, p = 0.192) and external-internal rotation (U = 8787.5, p = 0.764) torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. Hip abduction-adduction torque ratio was higher (p = 0.0127) in patients with a severe state (median = 1.80, IQR = 0.61) when compared to asymptomatic individuals (median = 1.52, IQR = 0.45) (moderate effect size, r = 0.45).

INTERPRETATION

Patients with severe symptoms and functional limitations related to FAI syndrome presented greater hip abduction-adduction torque ratio than asymptomatic individuals, suggesting a decreased adduction torque capacity relative to abduction torque in this subgroup of femoroacetabular impingement.

Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden

BACKGROUND

Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services.

AIM

To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden.

METHODS

Swedish Hip Arthroplasty Register PRO data during 2008-2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision.

RESULTS

1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29-0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01-1.87).

CONCLUSION

No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.

Feasibility and acceptability of a six-month exercise and patient education intervention for patients with hip dysplasia: A mixed methods study

BACKGROUND AND OBJECTIVES

To evaluate the feasibility and acceptability of exercise and patient education for patients with hip dysplasia not receiving surgery.

DESIGN

Feasibility study.

METHODS

The participants received exercise instruction and patient education over six months. Feasibility covered recruitment, retention, and mechanisms of change (MC). MC were measured with Hip and Groin Outcome Score (HAGOS), muscle strength tests, Y-balance test, and hop for distance test (HDT) over six months. Acceptability covered adherence, expectations, perceptions, benefits, and harms.

RESULTS

Thirty of 32 were recruited (median age: 30 years); six were lost to follow-up. Twenty-four participants improved by a mean of 11 (95%CI: 5-17) HAGOS pain points, improvements in all subscales were 1-11 points. Mean hip abduction strength improved 0.2 (95%CI: 0.04-0.4) Nm/kg, similar to flexion and extension. Median Y-balance test improvements: anterior: 70 (IQR: 64-74) to 75 (IQR: 72-80) centimetres; posteromedial: 104 (IQR: 94-112) to 119 (IQR: 112-122) centimetres and posterolateral: 98 (IQR: 89-109) to 116 (IQR: 108-121) centimetres (p < .001). Median improvement in HDT was: 37 (IQR: 30-44) to 52 (IQR: 45-58) centimetres (p < .001). Participants adhered to 84% of scheduled sessions (1,581:1,872), expectations were met, and perceptions were characterized by high self-efficacy for exercise. Benefits were reported with no serious harms.

CONCLUSION

Patients with hip dysplasia are willing to be recruited for exercise and patient education, with acceptable retention. MC were observed through improvements in pain, strength and function with high acceptance of the exercise and patient education intervention. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Do femoral version abnormalities play a role in hip function of patients with hip pain?

BACKGROUND

A high prevalence of femoral version abnormalities has been observed in hip pain patients, with impact on hip range of motion and muscle strength that should be elucidated.

METHODS

Cross-sectional study. Thirty-one patients with hip pain (16 men and 15 female) were subjected to Biplanar X-Rays to quantify femoral version using three-dimensional measurements. The 62 hips were divided into normal version (10-20°, n = 18), anteverted (>20°, n = 19), and retroverted (<10°, n = 25). Joint range of motion for flexion, internal rotation, and external rotation was assessed through digital goniometry. Maximal isometric hip strength (flexion, extension, internal rotation, external rotation at 0° and 30°, abduction, adduction) was evaluated through hand-held dynamometry. Hip rotation index was calculated as external rotation minus internal rotation.

FINDINGS

Anteverted hips had greater internal rotation, while retroverted hips had greater external rotation (p = 0.001). Anteverted hips were weaker than retroverted hips for external rotation at 30° (p < 0.001), abduction (p = 0.006) and adduction (p < 0.001), and weaker than normal version hips for extension (p = 0.018). All three groups had different rotation index: retroverted>normal>anteverted (p < 0.001). The ordinal logistic regression found higher values of rotation index with higher probability of being retroverted (common odds ratio = 1.20). There was a strong correlation between femoral version group and rotation index (r_S = 0.76, p < 0.001). There was probability >70% of a hip being anteverted if the rotation index was <11°, and being retroverted if the index was >40°.

INTERPRETATION

Range of motion and muscle strength differed in hips with different femoral versions. The hip rotation index was a strong femoral version predictor.

Intra-articular injection of monoiodoacetate induces diverse hip osteoarthritis in rats, depending on its dose

BACKGROUND

Monoiodoacetate (MIA)-induced arthritis models are used widely in osteoarthritis (OA) research to develop effective conservative treatments for hip OA, as an alternative to joint replacement surgery. In joint OA models, such as the MIA-induced knee OA model, various doses of MIA are utilized, depending on the purpose of the research. So far, only 2 mg of MIA has been used for MIA-induced hip OA research. We hypothesized that the amount of MIA should be adjusted according to the osteoarthritis model under investigation. We performed radiographic and histological evaluations in rats for hip OA models induced by different doses of MIA.

METHODS

One hundred and eighty right hips of six-week-old, male Sprague-Dawley rats (n = 30 rats per group) were treated with either a single intra-articular injection of various doses of MIA (0.25, 0.5, 1.0, 2.0, and 4.0 mg) dissolved in 25 μl of sterile saline (MIA group), or with 25 μl of sterile saline alone (Sham group). Radiographic and histological evaluations of the hip joint were performed at one, two, four, eight, and 12 weeks after administration (n = 6 rats per group per time point).

RESULTS

OA changes progressed from 1 week after administration in the 1.0-mg, 2.0-mg, and 4.0-mg MIA groups. The degree of OA changes increased as the dose of MIA increased. The 0.25-mg and 0.5-mg MIA groups presented fewer OA changes than the 2.0-mg and 4.0-mg MIA groups during the entire study period (up to 12 weeks). The administration of 0.25 mg and 0.5 mg of MIA-induced both radiographic and histological OA changes in a time-dependent manner, whereas more than 2 mg of MIA provoked end-stage OA at 8 weeks after injection. Absolute, dose-dependent histopathological OA changes were observed 4 weeks after MIA administration.

CONCLUSIONS

Intra-articular MIA injection to the hip joints of rats induced diverse OA changes dose-dependently. Research for developing novel conservative treatments for hip OA and intractable pain should consider the pathological condition when determining the dose of MIA to be employed.

Multiple stress fractures of unilateral femur: A case report

BACKGROUND

Stress fractures of the femoral neck are not common in clinical practice, and simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur are even more rare. We introduce a case of this type of fracture that was treated in our department, analyze the causes, and review similar stress fractures reported in the literature to provide references for the diagnosis and treatment of such conditions.

CASE SUMMARY

A 62-year-old female, with a free medical history, was admitted to the hospital mainly due to pain in the right hip and worsening pain in the right thigh. The patient had no obvious history of trauma. X-ray and computed tomography showed fracture of the femoral neck and proximal femur. The patient had undergone surgery 1 year prior to address a fracture of the left proximal femur that had occurred in a traffic accident. Our first consideration was stress fracture of the femoral neck; however, simultaneous stress fractures of the femoral neck and proximal femur of the unilateral femur were seen. The femoral neck stress fracture was a tension fracture, with obvious displacement and varus deformity of the hip. Considering that the patient was an elderly female, we performed total hip arthroplasty. Follow-up X-rays showed that the stress fracture of the proximal femur had mostly healed after 3 mo.

CONCLUSION

Muscle fatigue and hip varus deformity provide an anatomical basis for the occurrence of femoral neck stress fractures.

Knee and hip dynamic muscle strength in individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy: A case-control study

Background The primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome. Methods One hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes. Findings Individuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06-0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49-0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05). Interpretation Individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants.

Relationship between hip muscle strength and hip biomechanics during running in people with femoroacetabular impingement syndrome

BACKGROUND

Hip muscle weakness and altered hip biomechanics during walking are often observed in people with femoroacetabular impingement syndrome, although little is known about biomechanics during higher impact tasks. The aim of our study was to explore relationships between hip muscle strength and hip biomechanics during running in people with femoroacetabular impingement syndrome, including exploring sex as an effect-modifier of this relationship.

METHODS

Forty-two adults with unilateral femoroacetabular impingement syndrome (20 females; age 18-50 years; alpha angle ≥60°) completed assessments of hip muscle strength and hip biomechanics during running. Strength was assessed using a hand-held dynamometer for the hip flexors, extensors, abductors, adductors, internal rotators, and external rotators. Hip biomechanics were assessed during overground running (3-3.5 m/s) using three-dimensional motion capture and a force plate. Linear models assessed the relationships between hip strength and hip biomechanics of the symptomatic limb, controlling for body mass and running velocity along with an interaction term (strength*sex).

FINDINGS

A significant negative relationship was observed between hip external rotator strength and hip frontal plane range of motion (i.e., excursion), independent of sex (estimate = -0.039, 95%CI -0.071 to -0.008, P = 0.02). Four sex-specific interactions were observed, with a significant positive relationship between hip external rotator strength and peak hip extension moment in women (estimate = -0.413, 95%CI -0.713 to -0.114, P = 0.01) but not in men.

INTERPRETATION

We found significant relationships between hip external rotator strength and stance phase running biomechanics, providing further understanding on two impaired physical measures that may inform exercise-based management strategies in femoroacetabular impingement syndrome.

[Arthroscopically assisted minimally invasive symphysioplasty for the treatment of pubic related groin pain]

OBJECTIVE

Therapy of pubic related groin pain via minimally invasive symphysioplasty.

INDICATIONS

Therapy of refractory pubic related groin pain based on osteitis pubis.

CONTRAINDICATIONS

Groin pain from causes other than pubic related groin pain.

SURGICAL TECHNIQUE

After a minimally invasive approach, an incision in the anterior capsule is made while protecting the dorsal capsule parts and the arcuate pubic ligament. The symphysis end plates are remodeled arthroscopically assisted using a surgical burr. The newly created pubic symphysis joint is filled with autogenous fibrin to support the formation of a new discus interpubicus.

POSTOPERATIVE MANAGEMENT

Partial weight-bearing for 4 weeks with 20 kg using crutches is recommended. During the first 4 weeks the range of motion should be restricted.

RESULTS

Since 2010, 10 athletes (7 men, 3 women; average age 34.1 ± 7.8 (23-47) years) have undergone arthroscopically assisted minimally invasive symphysioplasty and treatment of femoroacetabular impingement syndrome. The average follow-up time was 5.1 (2-9) years. All patients returned to their sport level. The mean preoperative Nonarthritic Hip Score (NAHS) of 64.4 ± 15.1 (32.1-86.5) points improved to a mean postoperative NAHS of 91.4 ± 9.8 (62.4-98.75) points (p < 0.0001). The average patient satisfaction (scale 0 to 10; 10 highest satisfaction) was 9.8 ± 0.4 (9-10).

Osteophyte size and location on hip DXA scans are associated with hip pain: Findings from a cross sectional study in UK Biobank

OBJECTIVE

It remains unclear how the different features of radiographic hip osteoarthritis (rHOA) contribute to hip pain. We examined the relationship between rHOA, including its individual components, and hip pain using a novel dual-energy x-ray absorptiometry (DXA)-based method.

METHODS

Hip DXAs were obtained from UK Biobank. A novel automated method obtained minimum joint space width (mJSW) from points placed around the femoral head and acetabulum. Osteophyte areas at the lateral acetabulum, superior and inferior femoral head were derived manually. Semi-quantitative measures of osteophytes and joint space narrowing (JSN) were combined to define rHOA. Logistic regression was used to examine the relationships between these variables and hip pain, obtained via questionnaires.

RESULTS

6807 hip DXAs were examined. rHOA was present in 353 (5.2%) individuals and was associated with hip pain [OR 2.42 (1.78-3.29)] and hospital diagnosed OA [6.01 (2.98-12.16)]. Total osteophyte area but not mJSW was associated with hip pain in mutually adjusted models [1.31 (1.23-1.39), 0.95 (0.87-1.04) respectively]. On the other hand, JSN as a categorical variable showed weak associations between grade ≥ 1 and grade ≥ 2 JSN with hip pain [1.30 (1.06-1.60), 1.80 (1.34-2.42) respectively]. Acetabular, superior and inferior femoral osteophyte areas were all independently associated with hip pain [1.13 (1.06-1.20), 1.13 (1.05-1.24), 1.10 (1.03-1.17) respectively].

CONCLUSION

In this cohort, the relationship between rHOA and prevalent hip pain was explained by 2-dimensional osteophyte area, but not by the apparent mJSW. Osteophytes at different locations showed important, potentially independent, associations with hip pain, possibly reflecting the contribution of distinct biomechanical pathways.

Validation of the French version of the Self-Administered International Hip Outcome Tool-12 Questionnaire and determination of the Minimal Clinically Important Difference (MCID) in the French speaking population

BACKGROUND

Patient-Reported Outcomes tools are becoming the gold standard in the evaluation of results in orthopaedic surgery. In 2012, the International Hip Outcome Tool-12 (iHOT-12) was developed. This self-administered questionnaire was designed to address the day-to-day clinical setting with faster completion and easier patient flow. In 2021, a French translation of the iHOT-33 questionnaire, from which the iHOT-12 is derived, proved to be valid. Since there is not data in French regarding iHOT-12, we performed a prospective study aiming to answer: (1) is this French version of the iHOT-12 questionnaire as valid, (2) can the minimal clinically important difference (MCID) value for patients undergoing hip arthroscopy for femoro-acetabular impingement (FAI) be defined?

HYPOTHESIS

It is hypothesized that the iHOT-12-Fr would be valid and responsive to change in a cohort treated for FAI.

PATIENTS AND METHODS

Using the COSMIN recommendations, a multicentric prospective cohort study was conducted to evaluate the reliability, validity, responsiveness and MCID of the iHOT-12-Fr.

RESULTS

In total, 101 patients were recruited for participation in the project. The reliability of the iHOT-12-Fr questionnaire was assessed with the intraclass correlation coefficient (ICC=0.84) and the internal consistency with a Cronbach's alpha (α=0.86). The standard error of measurement (SEM=6.7) and the smallest detectable change (SDC=1.8) were calculated. Construct validity was evaluated with Pearson's correlation coefficients (r) by comparing the iHOT-12-Fr with the iHOT-33-Fr (r=0.96), the Hip disability and Osteoarthritis Outcome Score-Fr (r=0.68) and Nonarthritic Hip Score-Fr (r=0.82). Responsiveness was shown with a standardized effect size of 1.18, standardized response mean of 0.73, responsiveness ratio of 1.4 and an MCID of 11 points.

DISCUSSION

Metrological qualities of the iHOT-12-Fr are comparable to the original version and other versions translated into different languages. This study proves that the French translation of the iHOT-12 is valid, reliable and compares to the original iHOT-12.

LEVEL OF EVIDENCE

IV prospective study.

The Brazilian hip and groin outcome score (HAGOS-Br): cross-cultural adaptation and measurement properties

BACKGROUND

Hip and groin pain or symptoms is a recurrent musculoskeletal complaint among young and active individuals. It is important to objectively measure functional limitations using patient-related outcomes that have been validated in the language of the target population.

OBJECTIVES

To perform a cross-cultural adaptation and to evaluate the measurement properties of the Hip and Groin Outcome Score (HAGOS) for the Brazilian population.

METHODS

We adapted the HAGOS to Brazilian Portuguese and evaluated the following measurement properties: internal consistency, test-retest reliability, measurement error, and structural and construct validity. The sample recruited consisted of active individuals between 18 and 55 years of age with long standing hip and groin pain and individuals who participated in sports with high physical demand of the hip and groin region.

RESULTS

A total of 103 athletes and physically active individuals of both sexes participated in this study. The HAGOS was successfully translated and culturally adapted to the Brazilian population. Factor analysis confirmed that the HAGOS consists of six subscales. The HAGOS-Br showed good internal consistency. The CFA revealed a Cronbach's alpha for the HAGOS subscales ranging from 0.86 to 0.96, test-retest reliability was substantial, with intraclass correlation coefficients ranging from 0.81 to 0.94 for the six subscales and an acceptable measurement error (standard error of measurement [SEM]=5.43-11.15 points; and smallest detectable chance [SDC]= 16.71-30.9 points). Good construct validity existed with more than 75% of the pre-defined hypotheses being confirmed. No ceiling or floor effects were observed.

CONCLUSION

The HAGOS-Br showed to be equivalent to the original version with adequate validity and reliability properties.

Hip and groin function and strength in male ice hockey players with and without hip and groin problems in the previous season- a prospective cohort study

OBJECTIVE

To describe and compare hip and groin strength and function of male ice hockey players over one season in players with and without hip and groin problems in the previous season.

DESIGN

Prospective cohort study.

SETTING

Swedish male ice hockey.

PARTICIPANTS

We followed 193 players from 10 teams during the 2017/2018 season.

MAIN OUTCOME MEASURES

Hip adduction and abduction strength, 5 s squeeze test (5SST), and self-reported hip and groin function (Hip and Groin Outcome Score). Changes over the season and differences between players with and without problems in the previous season were analyzed by linear mixed models.

RESULTS

Adduction strength decreased slightly from pre-to mid-season and abduction strength increased slightly over the full season. However, self-reported function or pain did not change. Players with hip and groin problems in the previous season had significantly worse self-reported function, and more groin pain during the 5SST compared to players without. Strength measurments did not differ between groups.

CONCLUSIONS

Hip muscle strength, groin pain, and self-reported function appear to remain stable throughout the season in male ice hockey players. Remaining impairments in players with problems in the previous season suggest that function does not recover by ice hockey participation alone.

Spontaneous iliopsoas tendon rupture: a case report and brief review

INTRODUCTION

This report aims to describe the epidemiology, clinical presentation, diagnostic workup, treatment, and rehabilitation, natural course, and possible risk factors of the rare entity spontaneous iliopsoas tendon rupture.

METHODS

One case of spontaneous iliopsoas tendon rupture was encountered. The patient was followed during the hospital stay, her journal was later reviewed, and one telephone follow-up after 90 days was performed. Structured reviews of the literature in the PudMed and Micromedex databases were performed.

RESULTS

The patient recovered fully within 6 weeks of conservative treatment with small doses of acetaminophen and opioid. The literature reviews yielded 14 previously reported spontaneous iliopsoas tendon ruptures but no strong evidence regarding possible risk factors.

CONCLUSION

Spontaneous iliopsoas tendon rupture is a rare event, typically occurring in the elderly female. MRI is generally diagnostic, but signs are also often present on CT scans and sometimes even on plain X-ray. Conservative treatment has an excellent prognosis of full recovery within 6 weeks. The evidence on possible risk factors is scarce and conflicting.

Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oxford Hip Score

Aims

The aim of this study was to perform a cross-cultural adaptation of Oxford Hip Score (OHS) to Indonesian, and to evaluate its psychometric properties.

Methods

We performed a cross-cultural adaptation of Oxford Hip Score into Indonesian language (OHS-ID) and determined its internal consistency, test-retest reliability, measurement error, floor-ceiling effect, responsiveness, and construct validity by hypotheses testing of its correlation with Harris Hip Score (HHS), vsual analogue scale (VAS), and Short Form-36 (SF-36). Adults (> 17 years old) with chronic hip pain (osteoarthritis or osteonecrosis) were included.

Results

A total of 125 patients were included, including 50 total hip arthroplasty (THA) patients with six months follow-up. The OHS questionnaire was translated into Indonesian and showed good internal consistency (Cronbach’s alpha = 0.89) and good reliability (intraclass correlation = 0.98). The standard error of measurement value of 2.11 resulted in minimal detectable change score of 5.8. Ten out of ten (100%) a priori hypotheses were met, confirming the construct validity. A strong correlation was found with two subscales of SF-36 (pain and physical function), HHS (0.94), and VAS (-0.83). OHS-ID also showed good responsiveness for post-THA series. Floor and ceiling effect was not found.

Conclusion

The Indonesian version of OHS showed similar reliability and validity with the original OHS. This questionnaire will be suitable to assess chronic hip pain in Indonesian-speaking patients.

Cite this article: Bone Jt Open 2021;2(9):765–772.

The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome : a cross-sectional evaluation of a prospective hip registry cohort

AIMS

Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies.

METHODS

In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD.

RESULTS

Out of 122 patients, 110 (90.2%) were female and 12 (9.8%) were male. We analyzed the radiographs of 122 hips (59 (48.4%) symptomatic left hips, and 63 (51.6%) symptomatic right hips). Average age at time of presentation was 34.2 years (SD 11.2). Frequency of LSTV was high (39% to 43%), compared to historic records from the general population, with Castellvi type 3b being the most common (60% to 63%). Patients with AD have increased L4 and L5 interpedicular distance compared to published values. Frequency of pars interarticularis defect was 4%. Intraclass correlation coefficient for hip and spine variables assessed ranged from good (0.60 to 0.75) to excellent (0.75 to 1.00). Severity of AD did not demonstrate significant correlation with frequency of radiological spine anomalies.

CONCLUSION

Patients with AD have increased frequency of spinal anomalies seen on standard hip radiographs. However, there exists no correlation between radiological severity of AD and frequency of spine anomalies. In managing AD patients, clinicians should also assess spinal anomalies that are easily found on standard hip radiographs. Cite this article: Bone Joint J 2021;103-B(8):1351-1357.

Yield of Plain Radiography in Addition to Ultrasound Among Children with Hip Pain

BACKGROUND

Children with limp or hip pain often undergo radiographs and ultrasound as part of their initial evaluation. Previous research suggests that hip radiography may have limited utility, and early use of ultrasound may safely reduce the use of radiographs.

OBJECTIVES

We sought to assess the utility of radiography in addition to ultrasound by evaluating the rate of bony abnormalities present on hip radiographs among children with and without effusion on ultrasound. We also assessed the agreement of point-of-care and Radiology-performed ultrasounds for the detection of effusion.

METHODS

This is a retrospective cohort study of children presenting to a pediatric emergency department with acute atraumatic limp or hip pain. Data from patients who received both hip ultrasound and hip radiography as part of their evaluation were analyzed. We included both point-of-care and Radiology-performed hip ultrasounds.

RESULTS

We identified 134 patients who received both hip ultrasound and hip radiographs. Sixty-eight patients (51%) had a hip effusion present on ultrasound and none of these had bony abnormalities on radiography (0%, 95% confidence interval 0-5.3%). Of the 66 patients (49%) who had no effusion on hip ultrasound, 2 patients were found to have a bony abnormality (3%, 95% confidence interval 0.4-10.5%). For patients who received both point-of-care and Radiology-performed ultrasound, the overall agreement for diagnosis of effusion was 92.6% (kappa = 0.82).

CONCLUSIONS

We observed that no children with an effusion on ultrasound had bony pathology on plain radiography, suggesting that the routine performance of hip radiography may not be indicated in all children. Future studies are needed to evaluate the negative predictive value of effusion in larger numbers of patients with known bony abnormalities.

Maximal hip muscle strength and rate of torque development 6-30 months after hip arthroscopy for femoroacetabular impingement syndrome: A cross-sectional study

OBJECTIVES

Reduced sports function is often observed after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Impaired muscle strength could be reasons for this. We aimed to investigate hip muscle strength after hip arthroscopy for FAIS and its association with sports function and participation.

DESIGN

Cross-sectional study.

METHODS

We included 45 patients (34 males; mean age: 30.6 ± 5.9 years) after unilateral hip arthroscopy for FAIS (mean follow-up [range]: 19.3 [9.8-28.4] months). Maximal isometric hip muscle strength (Nm/kg) including early- (0-100 ms) and late-phase (0-200 ms) rate of torque development (Nm∗kg^-1∗s^-1) for adduction, abduction, flexion, and extension was measured with an externally fixated handheld dynamometer and compared between operated and non-operated hip. Associations between muscle strength and self-reported sports function and return to sport were investigated.

RESULTS

For maximal hip muscle strength, no between-hip differences were observed for adduction, abduction, flexion, and extension (p ≥ 0.102). For rate of torque development, significantly lower values were observed for the operated hip in flexion at both 0-100 ms (mean difference: 1.58 Nm∗kg^-1∗s^-1, 95% CI [0.39; 2.77], p = 0.01) and 0-200 ms (mean difference: 0.72 Nm∗kg^-1∗s^-1, 95% CI [0.09; 1.35], p = 0.027). Higher maximal hip extension strength was significantly associated with greater ability to participate fully in preinjury sport at preinjury level (odds ratio: 17.71 95% CI [1.77; 177.60]).

CONCLUSIONS

After hip arthroscopy for FAIS subjects show limited impairments in maximal and explosive hip muscle strength between operated and non-operated hip. Higher muscle strength was positively associated with higher sports function and ability to participate in sport.

How not to miss infective causes of hip pain in children

A referral from accident and emergency for a child with hip pain is a scenario commonly faced by orthopaedic juniors on call. The list of differentials is vast and can make assessment and diagnosis challenging, with severe consequences if diagnosis is delayed or missed. Three common causes of paediatric hip pain are septic arthritis, transient synovitis and osteomyelitis. These can all present as a child with atraumatic hip pain, irritability, fever and refusal to weight bear. Differentiating between them can be challenging. A thorough history and examination, combined with appropriate investigations and imaging, is essential. Early diagnosis and prompt treatment are key to reducing irreversible secondary sequelae of joint destruction and long-term functional impairment.

Validation of the French version of the self-administered international hip outcome tool-33 questionnaire

INTRODUCTION

To evaluate the effectiveness of new treatments, whether conservative or surgical, a self-administered questionnaire for hip pain targeted at physically active patients 18 to 60 years of age, named the international Hip Outcome Tool-33 (iHOT-33), was developed and validated in 2012. Since there is no French version available and we are acutely aware of transcultural variations, we conducted a prospective study to: 1) translate, and then 2) validate this questionnaire into international French.

HYPOTHESIS

The iHOT-33-Fr questionnaire is a valid and reliable tool for evaluating hip pain in a young, francophone population.

MATERIALS AND METHODS

Translation of the questionnaire was done according to the standardized method described by Beaton and the final version of the iHOT-33-Fr was validated using the COSMIN methodology. The data were collected prospectively at multiple sites. The reliability of the iHOT-33-Fr questionnaire was evaluated using the intraclass correlation coefficient (ICC) and its internal consistency using Cronbach's alpha. The standard error of measurement and minimum detectable change were calculated. The construct validity was evaluated using Pearson's correlation coefficient by comparing the iHOT-33-Fr with the Hip disability and Osteoarthritis Outcome Score (HOOS-Fr) and Nonarthritic Hip Score (NAHS-Fr).

RESULTS

In all, 101 patients filled out the questionnaires. The ICC was 0.87. The Cronbach alpha was 0.95. The standard error of measurement was 6.4 and the minimum detectable change was 1.8. The correlation between the iHOT-33-Fr and the HOOS-Fr was 0.86, while the correlation between the iHOT-33-Fr and the NAHS-Fr was 0.75.

DISCUSSION

Our results show that the metrological qualities of the iHOT-33-Fr are comparable to those of the original version and the versions translated into other languages. This study demonstrates that the iHOT-33-Fr is valid, reproducible and comparable to the original iHOT-33. It can be used by francophone surgeons treating symptomatic hip disease in young, active patients.

LEVEL OF EVIDENCE

IV.

Evaluation of Athletes with Hip Pain

Hip pain is a common complaint in athletes and can result in a significant amount of time lost from sport. Diagnosis of the source of hip pain can be a clinical challenge because of the deep location of the hip and the extensive surrounding soft tissue envelope. Establishing whether the source of hip pain is intra-articular or extra-articular is the first step in the process. A thorough history and a consistent and comprehensive physical examination are the foundation for the proper management of athletes with hip pain.

[Differential diagnoses of inflammatory hip joint]

Die Differenzialdiagnosen der entzündlichen Hüfterkrankung spielen für die Diagnose des Hüftschmerzes eine bedeutende Rolle. Die rheumatologischen/entzündlichen Veränderungen des Hüftschmerzes mit dem entsprechenden Einsatz der Bildgebung wurden in Teil 1 des CME-Artikels abgehandelt. In diesem zweiten Teil wird ein systematischer Zugang erläutert, um die zahlreichen rheumatologischen Erkrankungen von Degenerationen, synovialen Tumoren und Infektionen zu unterscheiden. Die Interpretation der Pathologien in der Bildgebung im Zusammenhang mit dem klinischen Erscheinungsbild wird für die einzelnen Differenzialdiagnosen genauer erläutert. Das zeitgleiche Auftreten von unterschiedlichen Erkrankungen, zum Teil als sekundäre Komplikation, hat einen erheblichen Einfluss auf die Therapieplanung und sollte vom Radiologen erkannt werden.

Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study

OBJECTIVE

To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS).

DESIGN

This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS.

RESULTS

Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS.

CONCLUSIONS

A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores.

[Inflammatory changes of the hip joint]

Die Osteoarthrose ist die häufigste Ursache für den Hüftschmerz des Erwachsenen. Daher wird anderen Ursachen wie z. B. Entzündungen weniger Beachtung für den Gelenkschmerz in der Erstdiagnose geschenkt. Dieser Artikel gibt eine Übersicht von unterschiedlichen rheumatologischen Erkrankungen der Hüfte und deren Interpretation in der Bildgebung. Die Vor- und Nachteile der einzelnen bildgebenden Verfahren werden anhand der pathologischen Befunde für die rheumatologischen Erkrankungen erläutert.

HIP AND GROIN PROBLEMS IN THE PREVIOUS SEASON ARE ASSOCIATED WITH IMPAIRED FUNCTION IN THE BEGINNING OF THE NEW SEASON AMONG PROFESSIONAL FEMALE ICE HOCKEY PLAYERS - A CROSS SECTIONAL STUDY

Background

Hip and groin problems are common in ice hockey but studies on professional female players are sparse. The available literature describes hip and groin problems by reporting incidence of time-loss injuries and may thereby underestimate the scope of these problems, which are often due to overuse and may not lead to absence from ice hockey participation.

Purpose

The purpose of this study was to describe the seasonal prevalence and severity of hip and groin problems in professional female ice hockey players. A further aim was to examine the relation between previous problems and self-reported function in the beginning of the new season.

Study design

Cross-sectional study.

Methods

Female ice hockey players from the highest league in Sweden [n=69 (19 goalkeepers, 18 defenders, 30 forwards)], responded to an online survey, retrospectively assessing the prevalence of hip and groin problems (time loss and non-time loss) and their duration during the previous season. Furthermore, players reported current self-reported function on the Copenhagen Hip and Groin Outcome Score (HAGOS).

Results

Two thirds of the players experienced hip and groin problems during the previous season [62.3% (N=43)]. A quarter of the players experienced a hip and groin problem leading to time loss [26.1% (N=18)]. The majority of problems were of short (1-2 weeks) or medium (3-5 weeks) duration [29% (N=20) of players, respectively], while longstanding problems ( ≥ 6 weeks) were rare [4,4% (N=3)]. Players that retrospectively reported hip and groin problems during the previous season reported statistically significant impairments on all HAGOS subscales in the beginning of the new season (p ≤ 0.011).

Conclusion

Hip and groin problems are prevalent in professional female ice hockey players, experienced by 62% during the previous season with resulting time-loss in 26.1%. Reported problems were rarely of longstanding nature, but players who reported problems in the previous season had significantly impaired hip and groin function in the beginning of the new season. Even though results of this study are based on retrospective player reports this may be a first step toward a greater understanding of the true burden of hip and groin players in professional female ice hockey players.

Level of evidence

3b.

Prevalence of femoro-acetabular impingement in non-arthritic patients with hip pain: a meta-analysis

PURPOSE

As the prevalence of femoro-acetabular impingement syndrome (FAIS) in symptomatic patients who lack evidence of hip osteoarthritis (OA) remains to be described, the purpose of this study was to calculate the prevalence of FAIS in this patient population.

METHODS

Libraries of PubMed, Embase, and Ovid were systematically reviewed for all studies between 2009 and 2019, investigating femoro-acetabular impingement and hip pain. Level I-IV studies delineating patients with hip pain who do not have OA (Tonnis or Outerbridge grades < three) were included. Demographics, outcomes, radiographic parameters, and criteria were entered into a meta-analysis to calculate the incidence of FAIS in non-arthritic symptomatic hips.

RESULTS

In total, 2264 patients (2758 hips) were included in the pooled analysis. Weighted mean age was 31 years. The incidence of FAIS in patients with no evidence of osteoarthritis but who complain of hip pain is 61% (47.3-74.4%). In total, 1483 hips were diagnosed with FAIS. Of the studies that described the rates of all three of the various subtypes of FAIS in their reports, 37% had a combined-type, 38% had a cam-type, and 25% had a pincer-type FAIS.

CONCLUSION

Femoroacetabular impingement should be suspected in 47 to 74% of patients with hip pain and without arthritis. Physicians must maintain a high index of suspicion for FAIS in young patients presenting with hip pain, as FAIS is a common and treatable condition that, if left alone, may lead to hip degeneration.

Impact of fluoroscopic injection location on immediate and delayed pain relief in patients with greater trochanteric pain syndrome

OBJECT

The purpose of this study was to assess whether fluoroscopically guided corticosteroid injections into the extrabursal tissues, trochanteric (subgluteus maximus) bursa, or subgluteus medius bursa provide better immediate and short-term pain relief.

MATERIALS AND METHODS

All fluoroscopically guided corticosteroid injections performed over a 67-month period for greater trochanteric pain syndrome were retrospectively reviewed. Procedural images were reviewed by two musculoskeletal radiologists to determine the dominant injection site based on final needle positioning and contrast spread pattern, with discrepancies resolved by consensus. Statistical analysis of the association between pain score reduction and dominant injection site was performed.

RESULTS

One hundred forty injections in 121 patients met the inclusion criteria. The immediate and 1-week post-injection pain reduction was statistically significant for trochanteric bursa, subgluteus medius bursa, and non-bursal injections. However, there was no statistically significant difference in the degree of pain reduction between the groups. There was statistically significant increase in the 1-week post-injection mean pain score compared with immediate post-injection mean pain score in the subgluteus medius bursa and non-bursal injection groups (p < 0.01) but not in the trochanteric bursa group.

CONCLUSION

Fluoroscopy is frequently chosen over blind injection or ultrasound guidance for trochanteric steroid injections in patients with a high body mass index. Our results indicate that fluoroscopically guided steroid injections into the trochanteric bursa and subgluteus medius bursa significantly reduced immediate and 1-week post-injection pain scores, as do non-bursal injections. Steroid injection into the subgluteus medius bursa and non-bursal sites may be less effective in maintaining pain reduction at 1-week post-injection.

Van Neck-Odelberg disease: A rare cause of pain in pediatric pelvis

Van Neck-Odelberg disease or ischiopubic osteochondritis, is a rare cause of pain in the pediatric pelvis due to late closure in synchondrosis ischiopubic, whose main symptom is an asymmetric pain that can cause a limitation in movement or limp. The different characteristics by images from simple radiography, computed tomography, MRI and bone scintigraphy scan will increase certainty diagnosis and will allow the correct differential diagnosis with fractures, posttraumatic osteolysis, infections or tumors, that leads to unnecessary invasive procedures, this being a benign disease with an evolution and improvement that occurs in weeks or months with conservative treatment. A case of a 15-year-old boy who consulted our hospital with an extra-institutional diagnosis of right ischiopubic fracture. After being evaluated by different imaging methods, a diagnosis of Van Neck-Odelberg or ischiopubic osteochondritis was made.

Hip pain and its correlation with cam morphology in young skiers-a minimum of 5 years follow-up

BACKGROUND

There is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers.

METHOD

All students (n = 76) at Åre Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (α-angle ≥ 55°) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire.

RESULTS

A total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip α-angle at 1 o'clock and hip pain in skiers with cam morphology at baseline (rs = 0.49; P = 0.03) and at follow-up (rs = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries.

CONCLUSION

Hip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.

Central sensitization inventory scores correlate with pain at rest in patients with hip osteoarthritis: a retrospective study

Background

Patients with persistent pain due to osteoarthritis (OA) complain of multiple symptoms that cannot be explained solely by structural changes. A poor correlation exists between structural and inflammatory changes in OA and pain levels. Central sensitization (CS) has been identified as a factor that induces chronic pain in patients with OA. Although it is important to identify osteoarthritis patients with CS components, the prevalence and characteristics of CS, especially those in patients with hip OA, are not well understood. Thus, we aimed to determine the prevalence and characteristics of CS in patients with hip OA, in this study.

Methods

The CS Inventory (CSI), used as a non-invasive routine clinical tool to evaluate the presence of CS 1 month before surgery in 100 patients with hip OA, was measured at our outpatient clinic, and the data were retrospectively reviewed. We determined the number of patients with a CSI score of 40 points or higher and assessed the relationships between the CSI score and clinical factors (including age, duration of hip pain, degree pain at rest and on activity, by using the visual analogue scale [VAS] and the Harris Hip Score) using the Spearman’s correlation coefficient.

Results

The mean age of participants was 63.9 ± 11.6 years, and there were 15 men and 85 women. All patients had hip OA, categorised as advanced and terminal stage (Tönnis grade 2–3) on preoperative plain radiography. The mean duration of hip pain was 4.2 ± 4.4 years. The mean CSI score was 19.5 ± 11.3 and 5 (5.0%) of the patients had a score of 40 or more points. CSI scores correlated significantly only with VAS pain at rest (r = 0.348, P < 0.001).

Conclusion

In this study, 1 out of every 20 hip OA patients had CS components. CSI scores were significantly correlated with pain at rest in hip OApatients. CS approaches to hip OA may be one of the treatment options for pain at rest.

Quantification of hip effusion-synovitis and its cross-sectional and longitudinal associations with hip pain, MRI findings and early radiographic hip OA

BACKGROUND

Hip effusion-synovitis may be relevant to osteoarthritis (OA) but is of uncertain etiology. The aim of this study was to describe the cross-sectional and longitudinal associations of hip effusion-synovitis with clinical and structural risk factors of OA in older adults.

METHODS

One hundred ninety-six subjects from the Tasmanian Older Adult Cohort (TASOAC) study with a right hip STIR (Short T1 Inversion Recovery) Magnetic Resonance Imaging (MRI) on two occasions were included. Hip effusion-synovitis CSA (cm2) was assessed quantitatively. Hip pain was determined by WOMAC (Western Ontario and McMaster Universities Osteoarthritis) while hip bone marrow lesions (BMLs), cartilage defects (femoral and/or acetabular) and high cartilage signal were assessed on MRI. Joint space narrowing (0-3) and osteophytes (0-3) were measured on x-ray using Altman's atlas.

RESULTS

Of 196 subjects, 32% (n = 63) had no or a small hip effusion-synovitis while 68% (n = 133) subjects had a moderate or large hip effusion-synovitis. Both groups were similar but those with moderate or large hip effusion-synovitis were older, had higher BMI and more hip pain. Cross-sectionally, hip effusion-synovitis at multiple sites was associated with presence of hip pain [Prevalence ratio (PR):1.42 95%CI:1.05,1.93], but not with severity of hip pain. Furthermore, hip effusion-synovitis size associated with femoral defect (βeta:0.32 95%CI:0.08,0.56). Longitudinally, and incident hip cartilage defect (PR: 2.23 95%CI:1.00, 4.97) were associated with an increase in hip effusion-synovitis CSA. Furthermore, independent of presence of effusion-synovitis, hip BMLs predicted incident (PR: 1.62 95%CI: 1.13, 2.34) and worsening of hip cartilage defects (PR: 1.50 95%CI: 1.20, 1.86). While hip cartilage defect predicted incident (PR: 1.11 95%CI: 1.03, 1.20) and worsening hip BMLs (PR: 1.16 95%CI: 1.04, 1.30).

CONCLUSIONS

Hip effusion-synovitis at multiple sites (presumably reflecting extent) may be associated with hip pain. Hip BMLs and hip cartilage defects are co-dependent and predict worsening hip effusion-synovitis, indicating causal pathways between defects, BMLs and effusion-synovitis.

Large spontaneous median sacral artery pseudoaneurysm masquerading as hip pain

We report the case of an 81-year-old man who presented with severe right hip pain and reduced physical function secondary to a large spontaneous median sacral artery pseudoaneurysm measuring 83.5 × 55.4 mm. The patient had no history of recent trauma, infective or inflammatory disease, or any recent procedures. The patient was taking apixaban for atrial fibrillation. Percutaneous coil embolization was used to occlude the pseudoaneurysm. This case describes a novel disease, spontaneous median sacral artery pseudoaneurysm, presenting with hip pain.

Survivorship Following Hip Arthroscopy: Lessons Learned from a Comprehensive Database

PURPOSE OF REVIEW

Hip arthroscopy and its indications continue to expand. Understanding the durability of hip arthroscopic procedures remains important not only for counseling patients, but also for determining the success of certain procedures or in certain populations. Survivorship is defined as the proportion of hip arthroscopy patients who have not yet gone on to periacetabular osteotomy (PAO), total hip arthroplasty (THA), and/or revision surgery. The purpose of this review is to summarize the recent literature pertaining to survivorship after certain hip arthroscopic procedures and certain special populations.

RECENT FINDINGS

There is yet to be level 1 evidence published with relation to survivorship following hip arthroscopy. The best evidence in the recent literature is contained in just rew long-term prospective studies demonstrating good to excellent survivorship following hip arthroscopy for femoroacetabular impingement (FAI). Unfortunately, the follow-up for other conditions treated by hip arthroscopy is more limited. In summary, hip arthroscopy indications continue to expand. The most common indication for surgery is FAI, and its recently published long-term survivorship demonstrates excellent durability. Other hip arthroscopic procedures, including labral reconstruction, adjunctive procedures such as capsular closure, and special populations such as athletes, also demonstrate excellent survivorship in shorter term follow-up. Further prospective research is needed to further define survivorship of various hip conditions, associated procedures, and special populations commonly treated with hip arthroscopy.

Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.

Translation, validation and test-retest reliability of the VISA-G patient-reported outcome tool into Danish (VISA-G.DK)

The Victorian Institute of Sport Assessment (VISA) questionnaire model is based on item response theory using a graded response (responses reflect increasing difficulty). The purpose of the VISA-G is to monitor patient outcomes and evaluate treatment strategies for people with greater trochanteric pain syndrome (GTPS). The primary aim of the current study was to translate and culturally adapt the VISA-G into a Danish context (DK) through forward and back translation and cognitive interviews. The second aim was to establish test–retest reliability and face validity of the VISA-G into a Danish context (DK). No major disagreements were observed between the original and translated versions of the questionnaire. A total of 58 heterogenous asymptomatic, and 49 symptomatic respondents (response rate: 92% and 78% respectively) completed the VISA-G.DK twice, 1 week apart. The VISA-G.DK had excellent internal consistency (Cronbach’s alpha: asymptomatic = 0.86; symptomatic = 0.98). The test–retest reliability was excellent for the total score: ICC: 0.961 (95% CI [0.933–0.978]). Standard Error Measurement was calculated to be 0.6. Bland–Altman plots showed no significant or relevant differences from test to retest in the total score with mean differences below 1 (0.61). The minimal detectable change was 3.17 for both groups. The VISA-G.DK was found to be valid, reliable and acceptable for use in the Danish population.