Medicine › Surgery

Hip disorders and treatments

Works Count: 58630

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Description

This cluster of papers focuses on femoroacetabular impingement syndrome, a condition where abnormal hip morphology leads to damage of the acetabular cartilage and labrum, potentially causing osteoarthritis. The papers cover topics such as radiographic diagnosis, surgical techniques, outcomes following hip arthroscopy, and the influence of hip morphology on joint mechanics.

Keywords

Femoroacetabular Impingement; Hip Arthroscopy; Acetabular Labrum; Hip Morphology; Osteoarthritis; Cam Deformity; Labral Tears; Hip Dysplasia; Arthroscopic Treatment; Hip Joint Mechanics

ANTERIOR FEMORO-ACETABULAR IMPINGEMENT DUE TO ACETABULAR RETROVERSION

2003-02-01

Klaus A. Siebenrock , Ralf Schoeniger , Reinhold Ganz

This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy.The diagnosis of femoro-acetabular impingement was based on … This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy.The diagnosis of femoro-acetabular impingement was based on clinical symptoms, a positive anterior impingement test, and findings of acetabular rim lesions on magnetic resonance imaging. The radiographic diagnosis of acetabular retroversion was based on the cross-over and posterior wall signs. Twenty-nine hips in twenty-two patients (average age, twenty-three years) underwent a periacetabular osteotomy. An arthrotomy was performed in twenty-six hips in order to visualize intra-articular lesions and, in selected cases, to improve a low femoral head-neck offset. The range of motion of the hip was measured, clinical evaluation was performed with use of the score described by Merle d'Aubigné and Postel, and the anterior center-edge angle of Lequesne and de Sèze was measured on radiographs preoperatively and at the time of the latest follow-up.The duration of follow-up averaged thirty months (range, twenty-four to forty-nine months). The anterior center-edge angle of Lequesne and de Sèze decreased significantly from a preoperative average of 36 degrees (range, 26 degrees to 52 degrees ) to a postoperative average of 28 degrees (range, 16 degrees to 46 degrees ) (p = 0.002). There was a significant increase in the average range of internal rotation (10 degrees, p = 0.006), flexion (7 degrees, p = 0.014), and adduction (8 degrees, p = 0.017). The average Merle d'Aubigné score increased from 14.0 points (range, 12 to 16 points) preoperatively to 16.9 points (range, 15 to 18 points) postoperatively (p < 0.001), and the result was good or excellent for twenty-six hips. Three hips underwent subsequent surgery: one, because of early postoperative loss of reduction; one, for correction of posteroinferior impingement; and one, because of recurrent signs of anterior impingement.Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion

The physiology of the joints

1974-01-01

I A Kapandji

The Biochemistry and Physiology of Bone

1956-09-01

Geoffrey H. Bourne

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Femoroacetabular Impingement

2003-12-01

Reinhold Ganz , Javad Parvizi , Martín Beck +3 more

A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, … A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.

EARLY DIAGNOSIS AND TREATMENT OF CONGENITAL DISLOCATION OF THE HIP

1962-05-01

Timothy Barlow

1. A simple test more sensitive than Ortolani's for the diagnosis of instability of the hip in the new-born is described. It takes only a few seconds to perform and … 1. A simple test more sensitive than Ortolani's for the diagnosis of instability of the hip in the new-born is described. It takes only a few seconds to perform and can be quickly taught to doctors, nurses and midwives. 2. About one infant in sixty is born with instability of one or both hips. Over 60 per cent of these recover in the first week of life, and 88 per cent in the first two months. The remaining 12 per cent are true congenital dislocations and persist unless treated, giving an incidence of 1·55 per thousand. 3. Treatment with the type of splint described begun within the first week is simple and effective, and gives a hip clinically normal long before the child begins to walk. 4. The concept of a pre-dislocation phase should be abandoned.

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Acute slipped capital femoral epiphysis

1993-08-01

Randall T. Loder , B. Stephens Richards , Paul Shapiro +2 more

To test the traditional classification system of slipped capital femoral epiphysis, we evaluated the presenting symptoms and radiographs of fifty-four patients and reclassified the slipped epiphyses as unstable or stable, … To test the traditional classification system of slipped capital femoral epiphysis, we evaluated the presenting symptoms and radiographs of fifty-four patients and reclassified the slipped epiphyses as unstable or stable, rather than acute, chronic, or acute-on-chronic. Slips were considered to be unstable when the patient had such severe pain that weight-bearing was not possible even with crutches. Slips were considered to be stable when the patient could bear weight, with or without crutches. We reviewed the records on fifty-five hips in which the slip would have been classified as acute because the duration of symptoms was less than three weeks; thirty of these were unstable and twenty-five were stable. All slips were treated with internal fixation. A reduction occurred in twenty-six of the unstable hips and in two of the stable hips. Fourteen (47 per cent) of the thirty unstable hips and twenty-four (96 per cent) of the twenty-five stable hips had a satisfactory result. Avascular necrosis developed in fourteen (47 per cent) of the unstable hips and in none of the stable hips. We were not able to demonstrate an association between early reduction and the development of avascular necrosis.

The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome.

1995-07-01

S B Murphy , Reinhold Ganz , M E Müller

To help to determine the natural history of residual dysplasia of the hip after skeletal maturity, we followed the status of the contralateral hip in 286 patients who had had … To help to determine the natural history of residual dysplasia of the hip after skeletal maturity, we followed the status of the contralateral hip in 286 patients who had had a total hip replacement for osteoarthrosis secondary to dysplasia. The initial radiographic findings in seventy-four patients in whom advanced osteoarthrosis later developed in the contralateral hip were compared with those in forty-three patients who had reached the age of sixty-five years without having had severe osteoarthrosis. No patient in whom the hip functioned well until the age of sixty-five years had had a center-edge angle of less than 16 degrees, an acetabular index of depth to width of less than 38 per cent, an acetabular index of the weight-bearing zone of more than 15 degrees, uncovering of the femoral head of more than 31 per cent, or an acetabulum in which the most proximal point of the dome had been at the lateral edge (zero peak-to-edge distance).

The acetabular rim syndrome. A clinical presentation of dysplasia of the hip

1991-05-01

Kaj Klaue , CW Durnin , Reinhold Ganz

The acetabular rim syndrome is a pathological entity which we illustrate by reference to 29 cases. The syndrome is a precursor of osteoarthritis of the hip secondary to acetabular dysplasia. … The acetabular rim syndrome is a pathological entity which we illustrate by reference to 29 cases. The syndrome is a precursor of osteoarthritis of the hip secondary to acetabular dysplasia. The symptoms are pain and impaired function. All our cases were treated by operation which consisted in most instances of re-orientation of the acetabulum by peri-acetabular osteotomy and arthrotomy of the hip. In all cases, the limbus was found to be detached from the bony rim of the acetabulum. In several instances there was a separated bone fragment, or 'os acetabuli' as well. In acetabular dysplasia, the acetabular rim is subject to abnormal stress which may cause the limbus to rupture, and a fragment of bone to separate from the adjacent bone margin. Dysplastic acetabuli may be classified into two radiological types. In type I there is an incongruent shallow acetabulum. In type II the acetabulum is congruent but the coverage of the femoral head is deficient.

Effect of Pelvic Tilt on Acetabular Retroversion: A Study of Pelves From Cadavers

2003-02-01

Klaus A. Siebenrock , Daniel F. Kalbermatten , Reinhold Ganz

Pelvic inclination is difficult to control on a standard radiograph of the pelvis and has a direct influence on the appearance of acetabular version. By defining the normal range of … Pelvic inclination is difficult to control on a standard radiograph of the pelvis and has a direct influence on the appearance of acetabular version. By defining the normal range of the distance between the symphysis and the sacrococcygeal joint on 86 standard anteroposterior radiographs of pelves a technique was developed to evaluate pelvic inclination. A statistically significant correlation between this distance and pelvic inclination was shown in four cadaver pelves. Acetabular retroversion signs (cross-over, posterior wall signs) were evaluated on normal pelves from cadavers (two females, two males) after mounting on a holding device and wire marking of the acetabular rims. Radiographs were taken 3 degrees stepwise through the range of 9 degrees inclination to 12 degrees reclination. At the neutral position, two acetabula appeared with both positive retroversion signs compared with none at 6 degrees reclination. At 9 degrees pelvic inclination all acetabula had both signs. Retroversion signs were significantly more pronounced and found at lower pelvic tilt angles in the pelves from males than from females. Evaluation of pelvic inclination will help to decrease measurement errors in assessment of acetabular orientation and femoral head coverage. This will be valuable in preoperative planning of reorientation procedures.

Contact pressures in the human hip joint measured in vivo.

1986-05-01

W. Andrew Hodge , R S Fijan , K L Carlson +3 more

The pressures on human articular cartilage have been measured in vivo. An instrumented femoral head prosthesis that telemeters interarticular pressure at 10 discrete locations 253 times per second was implanted … The pressures on human articular cartilage have been measured in vivo. An instrumented femoral head prosthesis that telemeters interarticular pressure at 10 discrete locations 253 times per second was implanted in apposition to natural acetabular cartilage. Data were acquired during surgery, recovery, rehabilitation, and normal activity, for longer than 1 year after surgery. Pressure magnitudes were synchronized with body-segment kinematic data and foot-floor force measurements so as to locate transduced pressure areas on the natural acetabulum and correlate movement kinematics and dynamics with local cartilage pressures. The data reveal very high local (up to 18 MPa) and nonuniform pressures, with abrupt spatial and temporal gradients, that correlate well both in magnitude and distribution with in vitro data and computer simulations of synovial joint mechanics. Peak pressures in vivo are, however, considerably higher than pressures measured in vitro under the putative forces experienced by the joint in life, particularly in normal movements where cocontraction occurs in agonist and antagonist muscles across the hip joint. Thus, extant gait-analysis studies which apply inverse Newtonian calculations to infer joint forces establish the lower limit on such forces, since such analyses include only the net muscular torques about the joint and cannot account for the contribution of the increment in joint force due to muscular cocontraction. Our data also contribute to the understanding of normal synovial joint tribology and the possible role of mechanical factors in the deterioration evident in osteoarthritis. Further, design criteria for both partial and total hip replacement prostheses and specific aspects of rehabilitation protocols following hip surgery (e.g., the extent to which crutches and canes unload the hip joint) warrant reconsideration in light of the extraordinary high pressures measured during the activities of daily living.

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Prospective analysis of hip arthroscopy with 2-year follow-up

2000-09-01

J. W. Thomas Byrd , Kay S. Jones

The Stability of the Hip in Children: A Radiological Study of the Results of Muscle Surgery in Cerebral Palsy

1980-07-01

Jørgen Reimers

(1980). The Stability of the Hip in Children: A Radiological Study of the Results of Muscle Surgery in Cerebral Palsy. Acta Orthopaedica Scandinavica: Vol. 51, No. sup184, pp. 1-100. (1980). The Stability of the Hip in Children: A Radiological Study of the Results of Muscle Surgery in Cerebral Palsy. Acta Orthopaedica Scandinavica: Vol. 51, No. sup184, pp. 1-100.

Anterior Femoroacetabular Impingement

2004-01-01

Martín Beck , Michael Leunig , Javad Parvizi +3 more

Femoroacetabular impingement has been shown to cause labral and chondral lesions and leads to osteoarthrosis of the hip. With the elimination of the pathogenic cause we hope to prevent or … Femoroacetabular impingement has been shown to cause labral and chondral lesions and leads to osteoarthrosis of the hip. With the elimination of the pathogenic cause we hope to prevent or delay additional degeneration of the hip. Fourteen men and five women with a mean age of 36 years (range, 21-52 years) were treated with a surgical dislocation and offset creation of the hip. The followup averaged 4.7 years (range, 4-5.2 years). Using the Merle d'Aubigné hip score, 13 hips were rated excellent to good, with the pain score improving from 2.9 points to 5.1 points at the latest followup. There was no avascular necrosis of the femoral head. Five of the 19 patients, two with Grade 2 osteoarthrosis, two with Grade 1 osteoarthrosis but severe acetabular cartilage damage, and one with untreated ossified labrum had subsequent total hip arthroplasty (THA). In the stable hips without subluxation of the head into the acetabular cartilage defect, no additional joint space narrowing occurred. Surgical dislocation with correction of femoroacetabular impingement yields good results in patients with early degenerative changes not exceeding Grade 1 osteoarthrosis. This procedure is not suitable for patients with advanced degenerative changes and extensive articular cartilage damage.

A New Periacetabular Osteotomy for the Treatment of Hip Dysplasias Technique and Preliminary Results

1988-07-01

Reinhold Ganz , Kaj Klaue , T S Vinh +1 more

A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through … A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31° for the vertical center-edge (VCE) angle of Wi-berg and 26° for the corresponding angle of Le-quesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indometha-cin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.

Mean 20-year Followup of Bernese Periacetabular Osteotomy

2008-04-30

Simon D. Steppacher , Moritz Tannast , Reinhold Ganz +1 more

The goal of the Bernese periacetabular osteotomy is to correct the deficient acetabular coverage in hips with developmental dysplasia to prevent secondary osteoarthrosis. We determined the 20-year survivorship of symptomatic … The goal of the Bernese periacetabular osteotomy is to correct the deficient acetabular coverage in hips with developmental dysplasia to prevent secondary osteoarthrosis. We determined the 20-year survivorship of symptomatic patients treated with this procedure, determined the clinical and radiographic outcomes of the surviving hips, and identified factors predicting poor outcome. We retrospectively evaluated the first 63 patients (75 hips) who underwent periacetabular osteotomy at the institution where this technique was developed. The mean age of the patients at surgery was 29 years (range, 13-56 years), and preoperatively 24% presented with advanced grades of osteoarthritis. Four patients (five hips) were lost to followup and one patient (two hips) died. The remaining 58 patients (68 hips) were followed for a minimum of 19 years (mean, 20.4 years; range, 19-23 years) and 41 hips (60%) were preserved at last followup. The overall mean Merle d'Aubigné and Postel score decreased in comparison to the 10-year value and was similar to the preoperative score. We observed no major changes in any of the radiographic parameters during the 20-year postoperative period except the osteoarthritis score. We identified six factors predicting poor outcome: age at surgery, preoperative Merle d'Aubigné and Postel score, positive anterior impingement test, limp, osteoarthrosis grade, and the postoperative extrusion index. Periacetabular osteotomy is an effective technique for treating symptomatic developmental dysplasia of the hip and can maintain the natural hip at least 19 years in selected patients. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Surgical dislocation of the adult hip

2001-11-01

Reinhold Ganz , Thomas J. Gill , Emanuel Gautier +3 more

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this … Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a 'trochanteric flip' osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage.

An in vitro investigation of the acetabular labral seal in hip joint mechanics

2003-01-30

Stephen J. Ferguson , J.T. Bryant , Reinhold Ganz +1 more

Anatomy, Histologic Features, and Vascularity of the Adult Acetabular Labrum

2001-01-01

Richard M. Seldes , Virak Tan , Jennifer L. Hunt +3 more

Acetabular labrum tears have been implicated as a cause of hip pain in adult patients. Few studies describe the anatomy, histologic features, and microvasculature of the acetabular labrum and labral … Acetabular labrum tears have been implicated as a cause of hip pain in adult patients. Few studies describe the anatomy, histologic features, and microvasculature of the acetabular labrum and labral tears. Fifty-five embalmed and 12 fresh-frozen adult hips with a mean age of 78 years (range, 61-98 years) were studied. Of these, 96 % (53 of 55) of the hips had labral tears, with 74% of the tears located in the anterosuperior quadrant. Histologically, the fibrocartilaginous labrum was contiguous with the acetabular articular cartilage through a 1- to 2-mm zone of transition. A consistent projection of bone extends from the bony acetabulum into the substance of the labrum that is attached via a zone of calcified cartilage with a well-defined tidemark. Two distinct types of tears of the labrum were identified histologically. The first consisted of a detachment of the fibrocartilaginous labrum from the articular hyaline cartilage at the transition zone. The second consisted of one or more cleavage planes of variable depth within the substance of the labrum. Both types of labral tears were associated with increased microvessel formation seen within the tear. The acetabular labrum tear appears to be an acquired condition that is highly prevalent in aging adult hips. Labral tears occur early in the arthritic process of the hip and may be one of the causes of degenerative hip disease.

Genetic determinants of bone mass in adults. A twin study.

1987-09-01

Nicholas Pocock , John A. Eisman , John L. Hopper +3 more

The relative importance of genetic factors in determining bone mass in different parts of the skeleton is poorly understood. Lumbar spine and proximal femur bone mineral density and forearm bone … The relative importance of genetic factors in determining bone mass in different parts of the skeleton is poorly understood. Lumbar spine and proximal femur bone mineral density and forearm bone mineral content were measured by photon absorptiometry in 38 monozygotic and 27 dizygotic twin pairs. Bone mineral density was significantly more highly correlated in monozygotic than in dizygotic twins for the spine and proximal femur and in the forearm of premenopausal twin pairs, which is consistent with significant genetic contributions to bone mass at all these sites. The lesser genetic contribution to proximal femur and distal forearm bone mass compared with the spine suggests that environmental factors are of greater importance in the aetiology of osteopenia of the hip and wrist. This is the first demonstration of a genetic contribution to bone mass of the spine and proximal femur in adults and confirms similar findings of the forearm. Furthermore, bivariate analysis suggested that a single gene or set of genes determines bone mass at all sites.

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The Etiology of Osteoarthritis of the Hip

2008-01-24

Reinhold Ganz , Michael Leunig , Katharina Leunig-Ganz +1 more

More than 90% of patients with so-called primary or idiopathic osteoarthritis of the hips in whom sufficient data were available to make an assessment of the normality of the hip … More than 90% of patients with so-called primary or idiopathic osteoarthritis of the hips in whom sufficient data were available to make an assessment of the normality of the hip joint at the cessation of growth clearly showed demonstrable abnormalities in the hip joint. The most common are mild acetabular dysplasia and/or pistol grip deformity. This latter deformity is associated with mild slipped capital femoral epiphysis (recognized or unrecognized at the time), Legg-Perthes' disease (recognized or unrecognized at the time), multiple epiphyseal dysplasia, spondyloepiphyseal dysplasia, and/or the presence of an intraacetabular labrum, as well as, in certain instances, acetabular dysplasia. When these abnormalities are taken in conjunction with the detection of other metabolic abnormalities that can lead to osteoarthritis of the hip and which may not be recognized readily, such as hemochromatosis, ochronosis, calcium pyrophosphate disease, and monarticular rheumatoid arthritis, it seems clear that either osteoarthritis of the hip does not exist at all as a primary disease entity or, if it does, is extraordinarily rare.

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The Role of Labral Lesions to Development of Early Degenerative Hip Disease

2001-12-01

Joseph C. McCarthy , Philip C. Noble , Michael Schuck +2 more

The current authors examined the hypothesis that labral lesions contribute to early degenerative hip disease. Between 1993 and 1999, 436 consecutive hip arthroscopies were done by the senior author. In … The current authors examined the hypothesis that labral lesions contribute to early degenerative hip disease. Between 1993 and 1999, 436 consecutive hip arthroscopies were done by the senior author. In addition, 54 acetabula were harvested from human adult cadavers. Two hundred forty-one of the 436 (55.3%) patients who had arthroscopies had a 261 labral tears, all located at the articular, not capsular margin of the labrum. Stereomicroscopic examination of the 54 acetabula from cadavers revealed 52 labral lesions. Overall, there was no significant difference between the arthroscopic and cadaveric populations in terms of the incidence of labral tears. (Overall, 73% of patients with fraying or a tear of the labrum had chondral change. Arthroscopic and anatomic observations support the concept that labral disruption and degenerative joint disease are frequently part of a continuum of joint disease.

Kinesiology of the Hip: A Focus on Muscular Actions

2010-01-14

Donald A. Neumann

Synopsis: The 21 muscles that cross the hip provide both triplanar movement and stability between the femur and acetabulum. The primary intent of this clinical commentary is to review and … Synopsis: The 21 muscles that cross the hip provide both triplanar movement and stability between the femur and acetabulum. The primary intent of this clinical commentary is to review and discuss the current understanding of the specific actions of the hip muscles. Analysis of their actions is based primarily on the spatial orientation of the muscles relative to the axes of rotation at the hip. The discussion of muscle actions is organized according to the 3 cardinal planes of motion. Actions are considered from both femoral-on-pelvic and pelvic-on-femoral perspectives, with particular attention to the role of coactivation of trunk muscles. Additional attention is paid to the biomechanical variables that alter the effectiveness, force, and torque of a given muscle action. The role of certain muscles in generating compression force at the hip is also presented. Throughout the commentary, the kinesiology of the muscles of the hip are considered primarily from normal but also pathological perspectives, supplemented with several clinically relevant scenarios. This overview should serve as a foundation for understanding the assessment and treatment of musculoskeletal impairments that involve not only the hip, but also the adjacent low back and knee regions. J Orthop Sports Phys Ther 2010;40(2):82–94. doi:10.2519/jospt.2010.3025

The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement

2002-05-01

Hubert P. Nötzli , Tobias Wyss , C. H. Stoecklin +3 more

Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this … Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this junction, and then to test it by its ability to distinguish quantitatively a group of patients with clinical evidence of impingement from asymptomatic individuals who had normal hips on examination. MR scans of 39 patients with groin pain, decreased internal rotation and a positive impingement test were compared with those of 35 asymptomatic control subjects. The waist of the femoral head-neck junction was identified on tilted axial MR scans passing through the centre of the head. The anterior margin of the waist of the femoral neck was defined and measured by an angle (alpha). In addition, the width of the femoral head-neck junction was measured at two sites. Repeated measurements showed good reproducibility among four observers. The angle alpha averaged 74.0 degrees for the patients and 42.0 degrees for the control group (p < 0.001). Significant differences were also found between the patient and control groups for the scaled width of the femoral neck at both sites. Using standardised MRI, the symptomatic hips of patients who have impingement have significantly less concavity at the femoral head-neck junction than do normal hips. This test may be of value in patients with loss of internal rotation for which a cause is not found.

Congenital Dysplasia and Dislocation of the Hip in Children and Adults

1987-01-01

Dietrich Tönnis

Biochemical and Metabolic Abnormalities in Articular Cartilage from Osteo-Arthritic Human Hips

1970-04-01

Henry J. Mankin , Louis Lippiello

Articular cartilage of the proximal end of the femur from twenty-four patients with osteo-arthritis and twenty "normal" controls with fractures of neck of the femur was obtained at the time … Articular cartilage of the proximal end of the femur from twenty-four patients with osteo-arthritis and twenty "normal" controls with fractures of neck of the femur was obtained at the time of surgical replacement of the femoral head and studied by histologic, histochemical, biochemical, and metabolic (isotopic) techniques. The data obtained demonstrated: 1. A decrease in the intensity of staining with safranin-O (a special stain for acid mucopolysaccharides) which correlated roughly with the severity of the osteo-arthritic process. 2. Essentially no change in the collagen content in the osteo-arthritic cartilage and a slight increase in the DNA and slight decrease in the hexosamine concentrations, neither of which were statistically significant. 3. A marked increase in the rates of DNA, protein and polysaccharide synthesis without significant change in the rate of RNA synthesis. 4. An inverse correlation of moderately high significance between the rates of polysaccharide synthesis and the levels of hexosamine. On the basis of these studies, it is postulated that the chondrocyte, under conditions of chronic stress as occurs in osteo-arthritis, seems to revert to a chondroblastic state and is capable of making new cells and matrix at a much more rapid rate than is normally seen.

Osteotomy through the Lesser Trochanter for Slipped Capital Femoral Epiphysis

1967-07-01

Wayne O. Southwick

The technique for accurate biplane osteotomy at the level of the lesser trochanter for the treatment of slipped capital femoral epiphysis by making reasonably accurate roentgenographic measurements is described and … The technique for accurate biplane osteotomy at the level of the lesser trochanter for the treatment of slipped capital femoral epiphysis by making reasonably accurate roentgenographic measurements is described and illustrated. Correction of one deformity by producing a reverse deformity at another level may not be esthetically appealing but an osteotomy through the lesser trochanter for slipped capital femoral epiphysis has the following advantages: 1. It does not seem to cause avascular necrosis of the head of the femur; 2. It does not open or directly assault the hip joint; 3. It seems to stimulate early closure of the slipped epiphyseal plate; 4. It does not prevent further corrective surgery at a second stage if need be; 5. If performed accurately it can be expected to restore hip function in almost every patient. Fifty-five patients have been treated by this method and avascular necrosis has not occurred. The results in twenty-six patients followed five years or more are reported in detail. Patients who have the complication of joint-space narrowing (not avascular necrosis) with joint stiffness should be given adequate time and rest, probably three years or more, to allow regeneration of the joint space to occur before consideration is given to reconstructive procedures. A possible mechanism for this narrowing and for the later restoration of the space is discussed.

The American Academy of Orthopaedic Surgeons Outcomes Instruments

2002-02-01

Frank G. Hunsaker , Dominic A. Cioffi , Peter C. Amadio +2 more

Background: The collection of population-based normative data is a necessary step in the process of standardization of eleven American Academy of Orthopaedic Surgeons (AAOS) musculoskeletal outcomes measures. These data serve … Background: The collection of population-based normative data is a necessary step in the process of standardization of eleven American Academy of Orthopaedic Surgeons (AAOS) musculoskeletal outcomes measures. These data serve as comparative normative scores with which to assess the effectiveness of treatment regimens in clinical practice settings and to study the clinical outcomes of treatment in musculoskeletal research. Methods: With use of a panel mail methodology, self-reported data on the eleven AAOS musculoskeletal outcomes measures were collected from the general population of the United States. Results: The overall response rate of 67.4% for the various surveys met study expectations. For the eleven measures, the range of the confidence intervals for the surveys was ±1.6% to ±2.3%, exceeding the ±3% set a priori. With use of the Multitrait/Multi-Item Analysis Program, all of the scales within each of eleven measures exhibited high internal reliability as well as discriminant and convergent validity. Items within each of the scales contributed roughly equal proportions of information to the total scale scores. Conclusions: All eleven instruments met study expectations for providing reliable and valid normative data for use in clinical and research settings.

The Aetiology of Primary Osteoarthritis of the Hip

1965-11-01

R. O. Murray

In most reports on osteoarthritis of the hip approximately half the patients have presented in adult life with no relevant antecedent history. In order to assess, in such cases of … In most reports on osteoarthritis of the hip approximately half the patients have presented in adult life with no relevant antecedent history. In order to assess, in such cases of so-called primary osteoarthritis, the presence of any minor pre-existing anatomical abnormality, the pelvic radiographs of 200 cases of this type were examined. No case in which the changes could be attributed to symptomatic disorder earlier in life was accepted. In this connection a few cases showing a protrusio acetabuli deformity were arbitrarily regarded as being secondary to inflammatory change of a rheumatoid nature and were therefore excluded. The cases were divided by visual assessment into those arising in the presence of (a) normal anatomy; (b) abnormal anatomy. The variations in the latter group included imperfect acetabular development—acetabular dysplasia—and an abnormal relationship of the femoral head to the femoral neck, comparable to the residual adult deformity of epiphysiolysis in adolescence. This abnormality was designated the tilt deformity. These different types showed somewhat different radiological features. Each hip, together with a control series of 100 hips, was then subjected to geometrical measurement. To assess acetabular dysplasia, the well recognised C E angle of Wiberg was used, but this was supplemented by a new measurement, the acetabular depth, which is considered to be simpler and more reliable when the joint architecture is disturbed by osteoarthritis. The tilt deformity required a new measurement—the femoral head ratio (FHR). The techniques for these measurements are described. These measurements, compared with the control series, were statistically significant (P<0·001) in the case of each of these anatomical abnormalities. Osteoarthritis arising in the presence of normal anatomy, here described as idiopathic, was found in 35 per cent with a female to male preponderance of approximately 4:1. The average age of onset of symptoms was 57·7 years. Osteoarthritis arising in the presence of abnormal anatomy accounted for the remaining 65 per cent. That associated with acetabular dysplasia represented 25·5 per cent of the whole series and also showed a female to male preponderance of approximately 4:1 with a rather earlier average age of onset of symptoms—50·8 years. This type appears to be a forme fruste of congenital dislocation of the hip. The tilt deformity was found in 39·5 per cent with a marked variation in sex incidence, approximately six males being affected for every female. The age of onset of symptoms in this group was 51·5 years. The balance of evidence suggests that this anatomical variation results from minor and unrecognised trauma in adolescence. It is considered that these minor anatomical variations can be recognised from more critical examination of pelvic radiographs and that their presence should indicate joint incongruity and potential osteoarthritic change. Conversely a normal adult pelvic radiograph makes the subsequent development of osteoarthritis of the hip much less likely. Earlier recognition of degenerative change may permit earlier treatment by osteotomy and arrest of the process of deterioration.

Anatomy of the medial femoral circumflex artery and its surgical implications

2000-07-01

Emanuel Gautier , K. Ganz , Nathalie Krügel +2 more

The primary source for the blood supply of the head of the femur is the deep branch of the medial femoral circumflex artery (MFCA). In posterior approaches to the hip … The primary source for the blood supply of the head of the femur is the deep branch of the medial femoral circumflex artery (MFCA). In posterior approaches to the hip and pelvis the short external rotators are often divided. This can damage the deep branch and interfere with perfusion of the head.

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Burden of major musculoskeletal conditions.

2003-01-01

Anthony D. Woolf , Bruce Pfleger

Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, … Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.

Femoroacetabular Impingement: Radiographic Diagnosis—What the Radiologist Should Know

2007-05-22

Moritz Tannast , Klaus A. Siebenrock , Suzanne E. Anderson

The purpose of this article is to show the important radiographic criteria that indicate the two types of femoroacetabular impingement: pincer and cam impingement. In addition, potential pitfalls in pelvic … The purpose of this article is to show the important radiographic criteria that indicate the two types of femoroacetabular impingement: pincer and cam impingement. In addition, potential pitfalls in pelvic imaging concerning femoroacetabular impingement are shown.Femoroacetabular impingement is a major cause for early "primary" osteoarthritis of the hip. It can easily be recognized on conventional radiographs of the pelvis and the proximal femur.

Total hip replacement in congenital dislocation and dysplasia of the hip.

1979-01-01

John F. Crowe , Vinodh Mani , C S Ranawat

The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in … The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one. The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent.

A Systematic Approach to the Plain Radiographic Evaluation of the Young Adult Hip

2008-11-01

John C. Clohisy , John C. Carlisle , Paul E. Beaulé +6 more

Clohisy, John C. MD; Carlisle, John C. MD; Beaulé, Paul E. MD; Kim, Young-Jo MD; Trousdale, Robert T. MD; Sierra, Rafael J. MD; Leunig, Michael MD; Schoenecker, Perry L. MD; … Clohisy, John C. MD; Carlisle, John C. MD; Beaulé, Paul E. MD; Kim, Young-Jo MD; Trousdale, Robert T. MD; Sierra, Rafael J. MD; Leunig, Michael MD; Schoenecker, Perry L. MD; Millis, Michael B. MD Author Information

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Avascular necrosis following treatment of congenital dislocation of the hip.

1980-09-01

Ali Kalamchi , G. Dean MacEwen

A review of 119 patients with congenital dislocation of the hip complicated by avascular necrosis, of whom fifty-one patients were skeletally mature, showed that damage to the physis was very … A review of 119 patients with congenital dislocation of the hip complicated by avascular necrosis, of whom fifty-one patients were skeletally mature, showed that damage to the physis was very common. Changes in the secondary ossification center (ossific nucleus) alone were found to be of very little value in predicting the nature of the development of the hip, while the change in the proximal femoral physis was the key to predicting residual deformity. The vascular disturbances were classified into four groups depending on the amount of damage involving the ossific nucleus and the physis during treatment of the dislocation. This classification was found to be accurate in predicting the natural history of avascular necrosis. The more severe forms of avascular necrosis were found to be most prevalent in those patients in whom treatment was begun between birth and the age of six months. We also found that preliminary traction and the use of general anesthesia reduced the incidence of the more severe form of avascular necrosis. The functional results found in the skeletally mature patients coincided with the types of vascular changes; the presence of avascular necrosis enhanced the development of arthritis, especially if residual dysplasia and subluxation also were present.

The natural history of Legg-Calvé-Perthes disease.

1981-09-01

S. David Stulberg , Daniel R. Cooperman , Richard Wallensten

Two groups of patients who had Legg-Calvé-Perthes disease were studied. The first group of patients consisted of eighty-eight patients (ninety-nine affected hips) followed in three hospitals for an average of … Two groups of patients who had Legg-Calvé-Perthes disease were studied. The first group of patients consisted of eighty-eight patients (ninety-nine affected hips) followed in three hospitals for an average of forty years. The second group consisted of sixty-eight patients (seventy-two affected hips), all of whose radiographs from the onset of disease to maturity were available and all of whom had been treated in one hospital. The patients in this second group were followed for an average of thirty years. Each hip in both study groups could be placed into one of five classes of deformity based on its radiographic appearance at maturity. Each class showed a characteristic pattern of involvement during the active stages of the disease and had a specific long-term clinical and radiographic course. The clinical and radiographic course of an involved hip subsequent to childhood was related to the type of congruency that existed between the femoral head and acetabulum. Three types of congruency were recognized: (1) spherical congruency (Class-I and II hips) - in hips in this category arthritis does not develop; (2) aspherical congruency (Class-III and IV hips) - mild to moderate arthritis develops in late adulthood in these hips; and (3) aspherical incongruency (Class-V hips) - severe arthritis develops before the age of fifty years in these hips.

THE NORMAL VASCULAR ANATOMY OF THE FEMORAL HEAD IN ADULT MAN

1953-08-01

Joseph Trueta , M. H. M. Harrison

1. The form and distribution of the blood vessels within the adult human femoral head are described. 2. It has been found possible to delimit the proximal femoral epiphysis in … 1. The form and distribution of the blood vessels within the adult human femoral head are described. 2. It has been found possible to delimit the proximal femoral epiphysis in mature years by reference to arterial form alone. 3. Two morphologically different sets of vessels are described interposed between the arterioles and venules of the bone marrow. One, a true capillary bed, lies mainly within the fat marrow; the other, constituted by sinusoids, lies within the red marrow. The departure of these findings from current views is noted. 4. A capillary system is described in relationship to the calcified zone of the articular cartilage. 5. No evidence has been found in support of the common belief that the circulation within the femoral head decreases quantitatively with advancing age.

Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction

2008-12-17

Marc J. Philippon , Karen K. Briggs , Y M Yen +1 more

Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral … Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy. The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing >or= 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032). Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction.

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Hip morphology influences the pattern of damage to the acetabular cartilage

2005-06-22

Martín Beck , Morteza Kalhor , Michael Leunig +1 more

Recently, femoroacetabular impingement has been recognised as a cause of early osteoarthritis. There are two mechanisms of impingement: 1) cam impingement caused by a non-spherical head and 2) pincer impingement … Recently, femoroacetabular impingement has been recognised as a cause of early osteoarthritis. There are two mechanisms of impingement: 1) cam impingement caused by a non-spherical head and 2) pincer impingement caused by excessive acetabular cover. We hypothesised that both mechanisms result in different patterns of articular damage. Of 302 analysed hips only 26 had an isolated cam and 16 an isolated pincer impingement. Cam impingement caused damage to the anterosuperior acetabular cartilage with separation between the labrum and cartilage. During flexion, the cartilage was sheared off the bone by the non-spherical femoral head while the labrum remained untouched. In pincer impingement, the cartilage damage was located circumferentially and included only a narrow strip. During movement the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification. Both cam and pincer impingement lead to osteoarthritis of the hip. Labral damage indicates ongoing impingement and rarely occurs alone.

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INNOMINATE OSTEOTOMY IN THE TREATMENT OF CONGENITAL DISLOCATION AND SUBLUXATION OF THE HIP

1961-08-01

Robert B. Salter

1. The problem of instability of reduction in congenital dislocation and congenital subluxation of the hip has been studied and it has been concluded that the basic cause of this … 1. The problem of instability of reduction in congenital dislocation and congenital subluxation of the hip has been studied and it has been concluded that the basic cause of this instability is the abnormal direction in which the entire acetabulum faces. 2. An operation, innominate osteotomy, has been designed to correct the abnormal direction of the entire acetabulum in children over the age of eighteen months. The principle of innominate osteotomy is redirection of the acetabulum so that the reduced dislocation or subluxation, which previously was stable only in a position of abduction and flexion, is rendered stable in the functional position of weight bearing. 3. The operative technique, and the pre-operative and post-operative management are described. 4. The indications for innominate osteotomy are outlined and the advantages of the operation are enumerated. 5. The early results of innominate osteotomy are very encouraging.

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Studies on Dysplastic Acetabula and Congenital Subluxation of the Hip Joint with Special Reference to the Complication of Osteo-Arthritis

1940-07-06

PERSISTENT JOINT LAXITY AND CONGENITAL DISLOCATION OF THE HIP

1964-02-01

Cedric Carter , John Wilkinson

1. General joint laxity affecting more than three joints was found in 7 per cent of normal schoolchildren. Similar laxity was found in fourteen of a random series of forty-eight … 1. General joint laxity affecting more than three joints was found in 7 per cent of normal schoolchildren. Similar laxity was found in fourteen of a random series of forty-eight girls, and in nineteen of twenty-six boys, with non-familial congenital dislocation of the hip. Such laxity was also found in four of seven girls and five of seven boys with familial (first degree relative affected) congenital dislocation of the hip. 2. It is concluded that persistent generalised joint laxity, which is often familial, is an important predisposing factor to congenital dislocation of the hip in boys. It is less important in girls, except perhaps in familial cases, as in girls there is an alternative temporary hormonal cause of joint laxity.

Normal Values of the Hip Joint for the Evaluation of X-rays in Children and Adults

1976-09-01

D. T NNE

*Assistant Professor of Orthopaedics, University of Muenster. Surgeon in Chief, Orthopaedische Klinik der Staedtischen, Kliniken Dortmund, D-46-Dortmund, F. R. Germany. *Assistant Professor of Orthopaedics, University of Muenster. Surgeon in Chief, Orthopaedische Klinik der Staedtischen, Kliniken Dortmund, D-46-Dortmund, F. R. Germany.

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

2016-09-14

Damian Griffin , Edward Dickenson , John O’Donnell +7 more

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members … The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016 , an open meeting held in the UK on 27–29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0–10. Substantial agreement (range 9.5–10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term ‘femoroacetabular impingement syndrome’ was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome. The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell’A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).

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ACETABULAR DYSPLASIA

1961-05-01

Ian Sharp

A simple method of measuring the degree of acetabular development in the radiograph of the adult pelvis is described and arguments for its validity are advanced. This measurement is referred … A simple method of measuring the degree of acetabular development in the radiograph of the adult pelvis is described and arguments for its validity are advanced. This measurement is referred to as the acetabular angle. The normal values for this angle are between 33 and 38 degrees. Angles below 32 degrees are uncommon and probably of no clinical significance, whereas angles from 39 to 42 degrees are in the upper limit of normality. An angle of 47 degrees is shown in a hip with congenital subluxation. The prognosis for hip joints with acetabular angles between 42 and 47 degrees is under investigation.

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Surgical dislocation of the adult hip

2001-11-01

Reinhold Ganz , Thomas J. Gill , Emmanuel L. Gautier +3 more

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this … Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a ‘trochanteric flip’ osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage.

Retroversion of the acetabulum

1999-03-01

D. Reynolds , J. Lucas , Kaj Klaue

We describe a little-known variety of hip dysplasia, termed ‘acetabular retroversion’, in which the alignment of the mouth of the acetabulum does not face the normal anterolateral direction, but inclines … We describe a little-known variety of hip dysplasia, termed ‘acetabular retroversion’, in which the alignment of the mouth of the acetabulum does not face the normal anterolateral direction, but inclines more posterolaterally.

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Femoroacetabular impingement and the cam-effect

2001-03-01

Keita Ito , M.-A. Minka-Ii , Michael Leunig +2 more

We have observed damage to the labrum as a result of repetitive acetabular impingement in non-dysplastic hips, in which the femoral neck appears to abut against the acetabular labrum and … We have observed damage to the labrum as a result of repetitive acetabular impingement in non-dysplastic hips, in which the femoral neck appears to abut against the acetabular labrum and a non-spherical femoral head to press against the labrum and adjacent cartilage. In both mechanisms anatomical variations of the proximal femur may be a factor. We have measured the orientation of the femoral neck and the offset of the head at various circumferential positions, using MRI data from volunteers with no osteoarthritic changes on standard radiographs. Compared with the control subjects, paired for gender and age, patients showed a significant reduction in mean femoral anteversion and mean head-neck offset on the anterior aspect of the neck. This was consistent with the site of symptomatic impingement in flexion and internal rotation, and with lesions of the adjacent rim. Furthermore, when stratified for gender and age, and compared with the control group, the mean femoral head-neck offset was significantly reduced in the lateral-to-anterior aspect of the neck for young men, and in the anterolateral-to-anterior aspect of the neck for older women. For patients suspected of having impingement of the rim, anatomical variations in the proximal femur should be considered as a possible cause.

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Etiology of Osteoarthritis of the Hip

1986-12-01

William H. Harris

More than 90% of patients with so-called primary or idiopathic Osteoarthritis of the hips in whom sufficient data were available to make an assessment of the normality of the hip … More than 90% of patients with so-called primary or idiopathic Osteoarthritis of the hips in whom sufficient data were available to make an assessment of the normality of the hip joint at the cessation of growth clearly showed demonstrable abnormalities in the hip joint. The most common are mild acetabular dysplasia and/or pistol grip deformity. This latter deformity is associated with mild slipped capital femoral epiphysis (recognized or unrecognized at the time), Legg-Perthes' disease (recognized or unrecognized at the time), multiple epiphyseal dysplasia, spondyloepiphyseal dysplasia, and/or the presence of an intraacetabular labrum, as well as, in certain instances, acetabular dysplasia. When these abnormalities are taken in conjunction with the detection of other metabolic abnormalities that can lead to Osteoarthritis of the hip and which may not be recognized readily, such as hemochromatosis, ochronosis, calcium pyrophosphate disease, and monarticular rheumatoid arthritis, it seems clear that either Osteoarthritis of the hip does not exist at all as a primary disease entity or, if it does, is extraordinarily rare.

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The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement

2002-05-01

Hubert P. Nötzli , Tobias Wyss , C. H. Stoecklin +3 more

Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this … Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this junction, and then to test it by its ability to distinguish quantitatively a group of patients with clinical evidence of impingement from asymptomatic individuals who had normal hips on examination. MR scans of 39 patients with groin pain, decreased internal rotation and a positive impingement test were compared with those of 35 asymptomatic control subjects. The waist of the femoral head-neck junction was identified on tilted axial MR scans passing through the centre of the head. The anterior margin of the waist of the femoral neck was defined and measured by an angle (α). In addition, the width of the femoral head-neck junction was measured at two sites. Repeated measurements showed good reproducibility among four observers. The angle α averaged 74.0° for the patients and 42.0° for the control group (p < 0.001). Significant differences were also found between the patient and control groups for the scaled width of the femoral neck at both sites. Using standardised MRI, the symptomatic hips of patients who have impingement have significantly less concavity at the femoral head-neck junction than do normal hips. This test may be of value in patients with loss of internal rotation for which a cause is not found.

Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures

1969-06-01

William H. Harris

An end-result analysis is presented of thirty-nine mold arthroplasties performed at the Massachusetts General Hospital between 1945 and 1965 in thirty-eight consecutive private patients for arthritis of the hip following … An end-result analysis is presented of thirty-nine mold arthroplasties performed at the Massachusetts General Hospital between 1945 and 1965 in thirty-eight consecutive private patients for arthritis of the hip following fractures of the acetabulum or dislocations of the hip. Of the nineteen unilateral cases in the second half of the series, sixteen were rated good or excellent. Results in the second half of the series were significantly better statistically than those in the first half of the series. Possible reasons for this improvement are discussed. No significant deterioration occurred with the passage of time. Among the thirty-nine hips, three revisions were required. One patient had postoperative sepsis after arthroplasty. Four patients who had had intra-articular sepsis prior to arthroplasty showed no evidence of sepsis postoperatively. Factors influencing the choice between hip fusion and hip arthroplasty in these cases are presented. A new system for rating hip function is proposed and is compared with the systems of Larson and Shepherd.

Radiographic and functional outcomes of shelf acetabuloplasty versus conservative management in legg-calvé-perthes disease: an age- and gender-matched study including healthy controls for isokinetic hip muscle strength

2025-06-25

Mehmet Demіrel , İlhan Sulejmani , Yaşar Samet Gökçeoğlu +3 more | International Orthopaedics

Abstract Introduction Shelf acetabuloplasty, one of surgical containment methods, have been employed to preserve hip joint congruity in the management of Legg-Calvé-Perthes disease (LCPD). However, its long-term effect on radiographic … Abstract Introduction Shelf acetabuloplasty, one of surgical containment methods, have been employed to preserve hip joint congruity in the management of Legg-Calvé-Perthes disease (LCPD). However, its long-term effect on radiographic and functional outcomes remains unclear due to limited evidence. Moreover, comparative studies against conservative treatment are lacking. This study aimed to (1) compare the mid- to long-term outcomes between children with advanced-stage LCPD treated with shelf acetabuloplasty and those receiving conservative management, and (2) evaluate isokinetic hip muscle strength compared to age- and gender-matched healthy controls. Materials and methods This retrospective age- and gender-matched study included 28 children with unilateral LCPD, divided into Shelf ( n = 14) and Conservative ( n = 14) treatment groups. A healthy control group ( n = 14) was also recruited for isokinetic comparisons. Radiographic outcomes were assessed using modified Stulberg classification and several quantitative parameters. Functional outcomes were assessed using the Harris Hip Score (HHS) and isokinetic testing of hip muscle strength. Results The Shelf group (median follow-up: 5.5 years, IQR: 4–7) showed significantly better HHS (67.9 ± 15.9) compared to the Conservative group (median follow-up: 6 years, IQR: 5–8) (54.6 ± 13.3; p = 0.024) at the final follow-up. Shelf acetabuloplasty also resulted in significantly improved radiographic parameters, including centre–edge angle ( p < 0.001) and femoral head coverage ( p = 0.002). Isokinetic testing revealed that the Conservative group had significantly lower hip extension ( p = 0.021), abduction ( p = 0.018), and adduction ( p = 0.027) torque values, as well as greater muscle fatigue ( p = 0.014). In contrast, the Shelf and Control groups exhibited comparable performance in most strength and endurance parameters. Conclusions Shelf acetabuloplasty, when applied as a salvage procedure in advanced-stage LCPD, may provide better functional outcomes and improved hip muscle performance compared to conservative treatment, despite comparable long-term femoral head morphology. Following Shelf acetabuloplasty, comparable hip flexor and extensor strength to healthy controls can be expected, although mild abductor and adductor weakness may persist.

Bone oedema‐like lesions at the enthesis of DIPJ collateral ligaments: MRI findings, management and outcome

2025-06-24

F. Cavallier , Federica Cantatore , Marco Marcatili +1 more | Equine Veterinary Education

Summary Bone oedema‐like lesion is characterised by hyperintense signal in short tau inversion recovery (STIR) sequences on magnetic resonance imaging (MRI). Bone oedema‐like lesions involving the enthesis of the collateral … Summary Bone oedema‐like lesion is characterised by hyperintense signal in short tau inversion recovery (STIR) sequences on magnetic resonance imaging (MRI). Bone oedema‐like lesions involving the enthesis of the collateral ligament (CL) of the distal interphalangeal joint (DIPJ) have not been investigated as a cause of lameness. This pattern was detected using low field MRI in nine forelimbs of eight horses. Lesions were found in the medial and the lateral collateral fossae of the distal phalanx in five and four feet; the lateral fossa of the middle phalanx was also abnormal in one foot. The STIR signal was graded as ‘severe’, ‘moderate’ and ‘mild’ in two, two and five feet, respectively, predominantly involved the dorsal two‐thirds of the fossa . The lesion was the only pathology in six feet, while in three, the ipsilateral CL presented abnormalities. Follow‐up MRI was available for two horses revealing a reduction in STIR signal. Five horses resumed a lower level of athletic activity, while three returned to the same or a higher level. Bone oedema‐like lesion at the CL enthesis is a potential cause of lameness even if the CL appears normal. The prognosis is good, although further studies with a larger number of horses are required.

Slipped capital femoral epiphysis (SCFE) a structured approach for the FRCS examination

2025-06-24

Suraj Kohli , Katie Gibbs , Themistoklis Vampertzis +4 more | European Journal of Orthopaedic Surgery & Traumatology

Quantitative Evaluation and Preoperative Planning Using Three‐Dimensional <scp>CT</scp> Profiles Improves the Accuracy of Bony Correction Under Primary Hip Arthroscopy and Clinical Outcomes in the Setting of Cam‐Type Femoroacetabular Impingement Syndrome

2025-06-23

Zheng Feng , Daofeng Wang , Guanyang Song +2 more | Orthopaedic Surgery

Residual cam deformity is the main cause of revision hip arthroscopy, and the precise correction of cam lesions is a crucial clinical problem. This study aimed to propose a novel … Residual cam deformity is the main cause of revision hip arthroscopy, and the precise correction of cam lesions is a crucial clinical problem. This study aimed to propose a novel quantitative evaluation and preoperative planning method based on 3D-CT profile analysis applied in primary hip arthroscopy for the treatment of cam-type femoroacetabular impingement syndrome (FAIS) and to evaluate the effect of this method. Consecutive patients who underwent primary hip arthroscopy for cam-type FAIS between April 2018 and August 2022 were enrolled in this study. According to the method assisting cam resection, the included patients were divided into the planning group and the control group. Patients' demographic characteristics, preoperative radiographic measurements, and intraoperative procedures were collected. Preoperative and postoperative anterior α angle (Aα) and lateral α angle (Lα) were measured on 3D-CT profiles, and the residual rates of anterior cam lesion (Ac) and lateral cam lesion (Lc) were calculated. Moreover, the 2-year postoperative clinical outcomes, including clinical scores and achieving rates of clinically significant outcomes, were compared between groups. Eventually, the planning group included 68 patients and the control group included 57 cases. There were no significant differences in demographic characteristics, preoperative radiographic measurements, and intraoperative procedures between groups (p > 0.05). Postoperatively, the mean postoperative Lα in the planning group was significantly smaller than that in the control group (43.4° ± 9.5° vs. 60.8° ± 20.8°, p < 0.001). Correspondingly, patients in the planning group had a significantly lower rate of residual Lc (9.4% vs. 62.5%, p < 0.001) and overall residual cam lesion (14.7% vs. 54.4%, p < 0.001) compared to cases in the control group. At 2-year follow-up postoperatively, patients in the planning group reported significantly superior scores of mHHS (91.0 ± 6.0 vs. 86.3 ± 8.5, p = 0.001), iHOT-12 (89.9 ± 7.2 vs. 82.7 ± 11.1, p < 0.001), and VAS for pain (1.2 ± 0.8 vs. 1.6 ± 1.1, p = 0.018) compared to patients in the control group. Moreover, the percentage of cases achieving patient acceptable symptom state (PASS) for mHHS in the planning group was significantly higher than that in the control group (97.1% vs. 84.2%, p = 0.012). Quantitative analysis using 3D-CT profiles is a reliable method for the evaluation of femoral morphology in patients with cam-type FAIS. Additionally, preoperative planning based on 3D-CT profiles can reduce the residual rate of cam lesions and improve short-term clinical outcomes in these patients who underwent primary hip arthroscopy.

Iliopsoas-Impingement

2025-06-23

Ingo J. Banke , Alexander Zimmerer , Jens Goronzy +2 more | Deleted Journal

Iliopsoas impingement refers to the painful contact between the iliopsoas tendon and the anterior acetabular rim of the hip joint. This mechanism can occur in the native hip as part … Iliopsoas impingement refers to the painful contact between the iliopsoas tendon and the anterior acetabular rim of the hip joint. This mechanism can occur in the native hip as part of an internal snapping hip syndrome and, in particular, following total hip arthroplasty, leading to chronic groin pain and a substantial reduction in the quality of life. This review article outlines the diagnostic approaches for identifying iliopsoas impingement and presents both established open procedures and innovative minimally invasive arthroscopic techniques for iliopsoas tendon release, in order to facilitate precise treatment planning and avoid potential complications.

Effect of altered gluteus maximus strength on the magnitude and direction of hip joint contact forces during simulations of gait

2025-06-23

Jay Patel , Madeline Grosklos , Cara L. Lewis +1 more | PLoS ONE

Femoroacetabular Impingement Syndrome (FAIS), a common and painful hip condition that affects active young adults, is associated with muscle weakness and altered movement patterns during common daily activities. FAIS is … Femoroacetabular Impingement Syndrome (FAIS), a common and painful hip condition that affects active young adults, is associated with muscle weakness and altered movement patterns during common daily activities. FAIS is believed to be a precursor to osteoarthritis through disrupted loading patterns; thus, understanding how weakness affects joint loading may provide insights into the pathogenesis from FAIS to osteoarthritis. The aim of this study was to examine the impact of gluteus maximus strength on hip joint contact forces during gait using musculoskeletal modeling. Twelve individuals with FAIS and 13 healthy controls were included in the study and five conditions of gluteus maximus strength (50%, 75%, 100%, 125%, and 150% of the model's default strength) were examined. Differences in the magnitude of the resultant joint contact force and directional components of the joint contact force between groups (FAIS vs controls) and between strength conditions were assessed with statistical nonparametric mapping. Joint contact forces were also used to determine the direction of hip loading in the sagittal and frontal planes and the center of the loading area was compared between groups and between strength conditions using independent t-tests and repeated measures analysis of variance, respectively. Joint contact force magnitude and direction did not differ between FAIS and control groups, aside from a brief period of larger medial force in the FAIS group. With both groups combined for remaining analyses, magnitude and direction of the joint contact force changed with the varied strength conditions; specifically, the 50 and 75% strength conditions demonstrated a lower magnitude joint contact force with a more anterior and medial direction. Importantly, these changes were small and of questionable clinical value. Future investigations should model movement changes alongside strength changes and use magnetic resonance imaging to examine a mechanistic link between load and intraarticular joint health.

Biochemical and Histologic Evaluation of Pulvinar Synovium Provides Insight Into Osteoarthritis Progression Secondary to Femoroacetabular Impingement

2025-06-22

Benjamin D. Kuhns , Dane R.G. Lind , Adam D. Goff +7 more | Journal of Orthopaedic Research®

ABSTRACT Recent studies have used femoroacetabular impingement (FAI) as a model for hip osteoarthritis, however, the cellular mechanisms underlying disease progression remain unclear. Pulvinar abnormalities within the cotyloid fossa are … ABSTRACT Recent studies have used femoroacetabular impingement (FAI) as a model for hip osteoarthritis, however, the cellular mechanisms underlying disease progression remain unclear. Pulvinar abnormalities within the cotyloid fossa are common findings during hip preservation surgery and total hip arthroplasty (THA). The purpose of this study was to compare histologic inflammation and gene expression of pulvinar synovial tissue in patients with FAI and patients with hip osteoarthritis secondary to FAI (FAI‐OA). Patients undergoing hip arthroscopy for FAI and THA for osteoarthritis with FAI morphology (FAI‐OA) were included. Macroscopic evaluation of the pulvinar for the FAI cohort was classified through the ligamentum‐fossa‐fovea complex (LFFC) grading system. RNA was isolated for reverse transcription‐polymerase chain reaction to evaluate the expression of inflammatory genes. Synovial samples were graded according to the histologic synovitis scoring system. Twenty‐nine patients were included in the study (17 FAI and 12 FAI‐OA). FAI patients had a lower pulvinar synovial score (2.3 ± 1.1) compared to FAI‐OA patients undergoing THA (3.6 ± 1.7; p = 0.04). Macroscopic pulvinar inflammation in the FAI cohort according to the LFFC classification was associated with worsening histologic synovitis ( r = 0.82; p < 0.001). There were no differences in gene expression between the FAI and FAI‐OA cohorts, while there was increased expression of IL1β, TGF‐β1, and PPARγ in subjects without significant pulvinar synovitis. Increased catabolic gene expression by the pulvinar tissue of patients without histologic synovitis earlier in the disease process may promote the development of worsening synovitis and contribute to articular cartilage degeneration. Statement of Clinical Significance Understanding the role of the pulvinar tissue within the hip, both macroscopically and biochemically, can help surgeons understand the complexities of the presentation and progression of osteoarthritis.

Anticipating Time Taken off Work After Bernese Periacetabular Osteotomy: A Single-Surgeon Experience of 282 Cases

2025-06-22

Bernard van Duren , Yash Pursun , Kane Teal +1 more | Arthroplasty Today

Slipped capital femoral epiphysis (SCFE)

2025-06-21

Mai Mohamed | Radiopaedia.org

Anatomical Mechanisms of Femoroacetabular Impingement and Its Role in the Progression to Hip Osteoarthritis: A Systematic Review

2025-06-20

Sundip Charmode , Sudhir S. Kushwaha , Abhishek Kumar Mishra +1 more | Cureus

Prognostic Significance of Metaphyseal Changes in Legg-Calvé-Perthes Disease

2025-06-20

Zhenbiao Li , C. Li , Xiaolin Luo +3 more | Journal of Pediatric Orthopaedics

Background: Previous studies have established the relationship between changes in the femoral head epiphysis and prognosis of Legg-Calvé-Perthes disease (LCPD), whereas the clinical significance of metaphyseal changes remains to be … Background: Previous studies have established the relationship between changes in the femoral head epiphysis and prognosis of Legg-Calvé-Perthes disease (LCPD), whereas the clinical significance of metaphyseal changes remains to be elucidated. This study aims to investigate the correlation between the type of metaphyseal changes and disease severity, as well as determine whether it is associated with the prognosis of LCPD based on radiographic outcomes after undergoing containment therapy. Methods: A retrospective analysis was conducted on the records of 105 patients with unilateral LCPD who underwent containment treatment. Three common types of metaphyseal changes were assessed using anteroposterior and frog-leg lateral radiographs, and the correlation between these change types and other clinical prognostic indicators was further analyzed. Univariate and multivariate logistic regression models were used to analyze potential risk factors affecting femoral head shape in children over 6 years of age, based on the Sphericity Deviation Score (SDS) was measured after epiphyseal healing, including age, stage at diagnosis, lateral pillar classification, Catterall classification, type of metaphyseal changes, and treatment method. Results: A total of 105 patients (mean age at diagnosis 6.8 y) were included. Among them, 6 showed no metaphyseal reaction, 45 had localized osteopenia, 29 exhibited cystic changes, and 25 presented with diffuse reactions. Of these patients, 40 received conservative treatment and 65 underwent surgeries. Surgical intervention significantly improved femoral head containment (extrusion index: 29.5±7.9 to 7.6±5.6, P <0.001). The frequency of spherical femoral heads after healing differed significantly among metaphyseal groups ( P <0.001), with the diffuse reaction group showing a higher rate of nonspherical femoral heads and significantly greater metaphyseal widening. Patients under 6 years had better outcomes than older children (88.9% vs. 56.5%, P =0.001). In patients over 6 years, multivariate analysis identified lateral pillar collapse (OR: 4.63, P =0.023) and diffuse metaphyseal reactions (OR: 7.31, P =0.009) as risk factors of poor femoral head sphericity. Cystic changes were not significantly associated with poor outcomes. Conclusion: Diffuse metaphyseal reaction is indicative of more severe condition in patients with LCPD, as well as its serve as a strong predictor of poor prognosis in patients over 6 years old, whereas metaphyseal cysts are less significant in predicting femoral head shape. Level of Evidence: Level III—prognostic study.

Top ten causes of non-arthritic hip pain: A comprehensive review

2025-06-18

Ping-Yen Yeo , Ayyadarshan Kasivishvanaath , Luís Pérez-Carro +1 more | World Journal of Orthopedics

Hip pain in young patients is a common complaint that can pose diagnostic challenges. Clinical evaluation of hip pain requires strong foundational knowledge of relevant anatomy, careful history-taking, focused physical … Hip pain in young patients is a common complaint that can pose diagnostic challenges. Clinical evaluation of hip pain requires strong foundational knowledge of relevant anatomy, careful history-taking, focused physical examination, and appropriate imaging techniques. Rapid advancements in hip arthroscopy techniques over the past decade has made it an essential tool in assessing and managing hip pain. This article aims to provide an evidence-based update on ten common causes of non-arthritic hip pain. These causes are categorized into three groups based on predominant symptom location to facilitate the readers' understanding and enhance evaluation of hip pain in the clinical setting. Each condition is discussed with an overview of relevant anatomy, clinical features and evaluation methods, as well as management strategies, emphasizing arthroscopic techniques where applicable.

Prevalence of developmental dysplasia of the hip in Al Jouf province, Saudi Arabia

2025-06-18

Ziad Ahmed Alanazi , Amirah Mojidea Mahdi Alshammari , Reem H. Al-Ruwaili +3 more | World Journal of Orthopedics

Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children. Its prevalence varies across different nations. To evaluate the prevalence of developmental hip dysplasia (DDH) within the pediatric … Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children. Its prevalence varies across different nations. To evaluate the prevalence of developmental hip dysplasia (DDH) within the pediatric population of Al Jouf province. From January 2018 to December 2023, children with DDH from all cities of Al Jouf were included in this retrospective cross-sectional study. The disease prevalence was calculated for the entire province as well as for individual cities within the territory. The study included 427 patients with DDH with an overall prevalence of 0.50%, or 5.0 per 1000 live births. At the city level, Sakaka had the highest prevalence at 14.2 per 1000 Live births followed by Qurayyat at 2.2 per 1000 live births. In contrast, cities like Suwayr, Abu Ajram, and Meegowa did not show any incidence of DDH. Significant differences were observed in the sociodemographic characteristics, such as age, sex, and nationality, across the different cities (P < 0.05). The prevalence of DDH in the Al Jouf province is high. The data delivers invaluable insights into the epidemiology of DDH in the Al Jouf locality. The findings highlight the need for targeted screening of DDH across the province.

Distinction Between Dysplasia, Malformation, and Deformity—Towards the Proper Diagnosis and Treatment of Hip Development Disorders

2025-06-18

Jacek Dygut , Monika Piwowar | Diagnostics

(1) Background: This publication focuses on processes that disrupt the proper development of the hip. Four pathomechanisms underlying human developmental defects are described in the literature, i.e., dysplasia, malformation, disruption, … (1) Background: This publication focuses on processes that disrupt the proper development of the hip. Four pathomechanisms underlying human developmental defects are described in the literature, i.e., dysplasia, malformation, disruption, and deformity. In the case of hip development, arguably the greatest challenge involves confusion between dysplasia and deformity, which often leads to misdiagnosis, incorrect nomenclature, and incorrectly chosen treatment. (2) Methods: A review of the scientific literature was performed. (3) Results: The paper presents a description of hip joint development disorders in the context of their pathomechanisms. An attempt was made to answer the question of whether these disorders are rooted in a primary disorder of tissue growth, resulting in incorrect anatomy, or are the result of anatomical deformations with secondary modifications in tissue structures-of a degenerative or adaptive nature-based on Delpech-Hueter-Volkmann growth and remodeling laws. In addition, the emphasis is placed on the presence of so-called clinically and diagnostically mute cases. We suggest augmenting diagnostic procedures with genetic tests to increase the sensitivity of screening. (4) Conclusions: Based on the arguments, a new division of developmental hip disorders is proposed.

Convex wrapping description of biarticular hip muscles for patient-specific musculoskeletal modeling

2025-06-17

Yanbing Wang , Jianqiao Guo , Hao Tang +1 more | Journal of Biomechanics

Clinical–Radiographic Dissociation in Early Hip Osteoarthritis in Postmenopausal Women

2025-06-17

Walter Martínez , E Bochatey , Fernando Lopreite | Archives of Orthopedics and Rheumatology

Inferior Hip Dislocation: The Uncommon Case of Hip Dislocation

2025-06-17

I Putu Arya Agung Pratama , I Wayan Suryanto Dusak | International Journal of Research and Review

Introduction: Inferior hip dislocation or commonly called as luxatio erecta femoris is an inferior dislocation of the femoral head and inversion of the femoral shaft that caused by traumatic event. … Introduction: Inferior hip dislocation or commonly called as luxatio erecta femoris is an inferior dislocation of the femoral head and inversion of the femoral shaft that caused by traumatic event. Case Description: This article reports a 42-year-old male with inferior hip dislocation. He came to our hospital with continuous, sharp pain in right hip since 2 hours prior to admission. There swelling, tenderness, and deformity in the right hip region. ROM is also limited due to pain in that area. We did an X-Ray and laboratory examination, then a diagnosis of inferior hip dislocation was made. Pain relievers, closed reduction, and immobilization with skin traction of 5 kg loads have been given to the patient. Discussion: Inferior hip dislocation is the rarest hip dislocation with only around 2-5% of all cases. Compared to other types of hip dislocation, it has a non-specific characteristic, so thoroughness is needed to diagnose the case. The mechanism of injury from inferior hip dislocation is still not fully understood, but it is generally the result of high energy trauma such as sports events and traffic accidents. When an inferior hip dislocation occurred, the distal end of the femur rises above the horizontal plane of the pelvis at the level of the acetabular fossae, and it flexes the hip to that extent. In this case, closed reduction management was performed by Allis maneuver technique. This method could be used when gentle traction method is failed with two maximum attempts for closed reduction. It is more frequently used in posterior hip dislocation but in our case, it was performed successfully. Post reduction radiograph is required to rule for completed reduction, and if there is any joint enlargement, a CT or MRI should be performed next. Conclusion: Hip dislocation has become more common as high-energy traffic accidents have escalated. Inferior hip dislocation is the rarest type of hip dislocation. Although it is uncommon, we could be able to identify and treat this case with great clinical results. Keywords: Inferior Hip Dislocation, Acetabulum, Allis Maneuver

Influence of pelvic incidence–lumbar lordosis mismatch on surgical outcomes of total hip arthroplasty: a retrospective cohort study

2025-06-17

Hisatoshi Ishikura , Toru Nishiwaki , Masatoshi Kudo +3 more | European Journal of Orthopaedic Surgery & Traumatology

Endoscopic management of ischiofemoral impingement (IFI): a systematic review

2025-06-16

Ahmed Elzeiny , Riccardo Giai Via , Andrea Donis +6 more | European Journal of Orthopaedic Surgery & Traumatology

Next-generation machine learning model to measure the Norberg angle on canine hip radiographs increases accuracy and time to completion

2025-06-16

G C Hansen , Yuxiao Yao , Anthony J. Fischetti +4 more | American Journal of Veterinary Research

Abstract Objective To apply machine learning (ML) to measure the Norberg angle (NA) on canine ventrodorsal hip-extended pelvic radiographs. Methods In this observational study, an NA-AI model was trained on … Abstract Objective To apply machine learning (ML) to measure the Norberg angle (NA) on canine ventrodorsal hip-extended pelvic radiographs. Methods In this observational study, an NA-AI model was trained on real and synthetic radiographs. Additional radiographs were used for validation and testing. Each NA was predicted using a hybrid architecture derived from 2 ML vision models. The NAs were measured by 4 authors, and the model all were compared to each other. The time taken to correct the NAs predicted by the model was compared to unassisted human measurements. Results The NA-AI model was trained on 733 real and 1,474 synthetic radiographs; 105 real radiographs were used for validation and 128 for testing. The mean absolute error between each human measurement ranged from 3° to 10° ± SD = 3° to 10° with an intraclass correlation between humans of 0.38 to 0.92. The mean absolute error between the NA-AI model prediction and the human measurements was 5° to 6° ± SD = 5° (intraclass correlation, 0.39 to 0.94). Bland-Altman plots showed good agreement between human and AI measurements when the NAs were greater than 80°. The time taken to check the accuracy of the NA measurement compared to unassisted measurements was reduced by 45% to 80%. Conclusions The NA-AI model proved more accurate than the original model except when the hip dysplasia was severe, and its assistance decreased the time needed to analyze radiographs. Clinical Relevance The assistance of the NA-AI model reduces the time taken for radiographic hip analysis for clinical applications. However, it is less reliable in cases involving severe osteoarthritic change, requiring manual review for such cases.

Defining Clinically Important Outcomes for the Modified Harris Hip Score and Nonarthritic Hip Scope for Hip Arthroscopy to Treat Femoroacetabular Impingement at a Minimum 10-Year Follow-up

2025-06-14

Emily Berzolla , L Chen , Griffith G. Gosnell +4 more | The American Journal of Sports Medicine

Background: The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) are valuable clinical thresholds used to provide clinical relevance to patient outcome scores. … Background: The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) are valuable clinical thresholds used to provide clinical relevance to patient outcome scores. In hip arthroscopy (HA) for femoroacetabular impingement (FAI) syndrome, these values have been defined for the short- and midterm postoperative period, but meaningful long-term thresholds have not been established. Purpose: To define the MCID, PASS, and SCB for the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at a minimum follow-up of 10 years for patients who underwent HA for FAI syndrome. Study Design: Case series; Level of evidence, 4. Methods: A retrospective cohort study including all patients who underwent primary HA for FAI with a single surgeon from February 2010 to December 2013 was performed. Patient outcomes were assessed with an anchor question, mHHS, and NAHS at baseline and at 1, 5, and 10 years of follow-up. MCID was calculated using the distribution-based method at all time points, using 0.5 standard deviations as the threshold. The anchor-based MCID, PASS, and SCB were calculated at 10 years using thresholds representing the optimal cutoff on a receiver operating characteristic curve. Correlations between baseline characteristics and achievement of the MCID, PASS, and SCB were assessed with binomial logistic regressions. Results: The 154 patients included in the study had a mean age of 38.8 ± 13.0 years, a mean body mass index of 24.6 ± 3.9 kg/m 2 , and 63.6% were female. The distribution-based MCID values for 1-year, 5-year, and 10-year scores were 7.8, 8.3, and 9.5 for mHHS and 9.5, 10.4, and 10.2 for NAHS, respectively. The anchor-based MCID was 20.3 for mHHS and 24.4 for NAHS. The PASS was 81.9 for mHHS and 83.1 for NAHS. The SCB values were 34.0 and 41.9 for mHHS and NAHS, respectively. Increased body mass index was associated with decreased achievement of SCB for mHHS ( P = .03) and NAHS ( P = .04), as well as NAHS PASS ( P = .01) and anchor-based MCID ( P = .01). Conclusion: The establishment of the MCID, SCB, and PASS for the NAHS and mHHS provides a valuable clinical context for improvements in outcome scores after HA. Anchor-based calculations were consistently higher than distribution-based calculations.

[Efficacy of establishing surgical access for hip arthroscopy using the combined internal-external approach].

2025-06-13

Qiyu Jia , Zhang Zhao , Yuan He +6 more | PubMed

Objective: To evaluate the clinical efficacy of the combined internal-external approach in establishing surgical portals for hip arthroscopy. Methods: A prospective analysis was conducted on patients who underwent hip arthroscopy … Objective: To evaluate the clinical efficacy of the combined internal-external approach in establishing surgical portals for hip arthroscopy. Methods: A prospective analysis was conducted on patients who underwent hip arthroscopy at the General Hospital of the People's Liberation Army from March 2021 to May 2023. The patients were divided into a trial group (using the combined internal-external approach) and a control group (using the traditional puncture method) based on their voluntary choices of surgical plans. All patients underwent imaging examinations before surgery. During the operation, the time taken to establish the anterolateral approach (AL approach), the time taken to establish the mid-anterior auxiliary approach (MA approach), and the total surgical time were recorded. After surgery, a 1-year follow-up was carried out. Indicators such as the visual analog scale (VAS) of pain, the modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12) score, the Hip Outcome Score-Activities of Daily Living Subscale (HOS-ADL), and the Hip Outcome Score-Sports Subscale (HOS-SSS) were recorded and compared for the two groups. Results: A total of 77 patients were enrolled with a mean age of (37.9±12.6) years(48 males and 29 females). There were 37 cases in the trial group[ with a mean age of (38.0±11.8) years, 24 males and 13 females] and 40 patients in the control group[ with a mean age of (37.8±13.4) years, 24 males and 16 females]. All indicators in both groups demonstrated significant improvement postoperatively compared with the preoperative values (all P<0.001). No significant intergroup differences existed in the indicators preoperatively (all P>0.05). Postoperatively, there was no significant defferences in VAS of pain [(2.3±2.1) vs (2.4±1.9) points], mHHS [(83.3±7.4) vs (80.2±9.2) points], iHOT-12 [(72.8±15.5) vs (71.1±17.4) points], HOS-ADL [(81.4±16.9) vs (84.0±15.0) points] and HOS-SSS [(55.7±23.4) vs (56.1±19.1) points] or AL approach time [(5.3±0.5) vs (5.4±0.4) minutes] between the trial group and the control group(all P>0.05); however, the MA approach time [(9.0±0.6) vs (14.8±1.3) minutes] and total operative time [(105.2±8.8) vs (119.4±4.7) minutes] in the trial group were both shorter than those in the control group (both P<0.001). The trial group had a lower postoperative complication rate than the control group, but the difference was not statistically significant [5.4% (2/37) vs 15.0% (6/40), P=0.263]. Conclusion: Portal establishment using the combined internal-external approach significantly reduces operative time and postoperative complication rate when compared to the traditional puncture technique, representing a safer and more efficient method for hip arthroscopy.

[Effect of preoperative timing for ultrasound-guided intra-articular hip anesthetic injection on post-arthroscopy infection and inflammation in patients with femoroacetabular impingement].

2025-06-13

Haohua Teng , Han Fu , Yuanbin Wu +7 more | PubMed

Objective: To investigate the relationship between preoperative ultrasound-guided intra-articular local anesthetics injection at different time points and postoperative infection risk and inflammatory response after hip arthroscopy in femoroacetabular impingement(FAI). Method: … Objective: To investigate the relationship between preoperative ultrasound-guided intra-articular local anesthetics injection at different time points and postoperative infection risk and inflammatory response after hip arthroscopy in femoroacetabular impingement(FAI). Method: This retrospective observational study enrolled FAI patients who underwent hip arthroscopy surgery at the General Hospital of the People's Liberation Army from May 2017 to October 2023. According to the time interval between intra-articular injection and the surgery, the patients were divided into four groups: injection time≤30 days prior to surgery, injection time between 30-90 days prior to surgery, injection time>90 days prior to surgery, and non-injection group. The temperature and peripheral blood inflammation indicators of patients within one week before surgery and during hospitalization after surgery were collected. The international hip joint score (IHOT-12), visual analogue scale (VAS) of pain and the modified Harris Hip Score (mHHS) before and within 12 months after surgery were collected. The postoperative infection rates, clinical scores, temperature and inflammatory markers between groups were compared. Results: A total of 425 patients were included, with 264 males and 161 females, aged (37.2±12.9) years. There were 152 cases in the≤30 d group, aged (36.9±12.5) years; 58 cases in the 30-90 d group, aged (41.4±13.2) years; 28 cases in the>90 d group, aged (37.3±12.0) years; and 187 cases in the non-injection group, aged (36.2±13.0) years. No acute and chronic infections were found in the enrolled patients, and 8 cases of suspected acute infections were found: 5 cases (2.7%) in the non-injection group, 2 cases (3.5%) in the 30-90 d group, 1 case (3.6%) in the>90 d group, and 0 case in the≤30 d group, and the difference in the proportion of patients with suspected acute infections among the various groups was not statistically significant (P=0.061). There were 17 patients with maximum body temperature≥38.0 ℃ on postoperative day 1, 9 (4.8%) in the non-injection group, 2 (7.1%) in the>90 d group, 1 (1.7%) in the 30-90 d group, and 5 (3.3%) in the≤30 d group. There were 143 patients with mildly elevated body temperature (37.1-37.9 ℃), 74 (39.6%) in the non-injection group, 10 (35.7%) in the>90 d group, 17 (29.3%) in the 30-90 d group, and 42 (27.6%) in the≤30 d group, and the difference in the proportion of the number of people with different degrees of fever among the groups was not statistically significant (P=0.180). The peripheral blood leukocyte level was 10.6 (8.5, 12.2) x109/L in the≤30 d group, 9.7 (7.8, 10.5) x109/L in the 30-90 d group, 8.9 (8.0, 10.7) x109/L in the>90 d group, 10.0 (7.9, 11.3) x109/L in the non-injection group, and peripheral blood leukocytes in the≤30 d group were significantly higher than those in the other three groups (all P<0.05). The differences in neutrophil ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate were not statistically significant among the groups after the surgery (all P>0.05). The IHOT-12, VAS of pain and mHHS scores of patients in all groups improved at 12 months after surgery when compared with the values before the operation (all P<0.001). Conclusion: Preoperative ultrasound-guided intra-articular hip anesthetic injection performed with standardized sterile technique does not increase postoperative infection risk or inflammatory response in FAI patients.

Management of Greater Trochanteric Pain Syndrome: A Narrative Review

2025-06-12

JasKiran K. Gill , Gregory Neal-Smith , Abdel Saed +2 more | Cureus

[Application efficacy of proximal anterior-distal anterolateral accessory in hip arthroscopic surgery].

2025-06-12

Zi‐Kuan Guo , Y B Li , Haohua Teng +7 more | PubMed

Objective: To explore the application effects of the proximal anterior-distal anterolateral accessory (PA-DALA) in hip arthroscopy for treating common hip diseases. Methods: A retrospective analysis was conducted on the clinical … Objective: To explore the application effects of the proximal anterior-distal anterolateral accessory (PA-DALA) in hip arthroscopy for treating common hip diseases. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent hip arthroscopic surgery at the Chinese People×s Liberation Army General Hospital from January 2018 to December 2023. The diseases included femoral acetabular impingement syndrome (FAI), ankylosing spondylitis (AS), synovial chondromatosis (SC), and pigmented villonodular synovitis (PVNS). Based on the different surgical approaches, the patients were divided into two groups: the control group underwent the conventional distal anterolateral approach (DALA) commonly used in hip arthroscopy, while the observation group received the PA-DALA approach. The application effects of the PA-DALA in hip arthroscopic surgery for common hip disorders were evaluated, and the incidence of intraoperative complications, postoperative wound healing, and functional scores such as the visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and International Hip Outcome Tool-12 (iHOT-12) at various follow-up time points before and after surgery (1, 3, 6 months and 1 year after surgery) were compared between the two groups. Results: A total of 102 patients with effective follow-up are included in the study, comprising 71 males and 31 females, aged (37.3±13.1) years. There were 34 cases in the control group, and 68 patients in observation group. In the control group, the preoperative VAS score of pain was (6.2±2.3) points, which decreased to (3.1±1.7) points one year after surgery; the preoperative mHHS score was (36.3±12.9) points, which increased to (77.7±9.3) points one year after surgery; and the preoperative iHOT-12 score was (29.5±15.4) points, which raised to (69.2±16.9) points one year after surgery. In the observation group, the preoperative VAS score of pain was (6.0±1.2) points, which decreased to (1.8±1.6) points one year after surgery; the preoperative mHHS score was (38.8±12.2) points, which increased to (81.0±9.5) points one year after surgery; and the preoperative iHOT-12 score was (32.8±12.6) points, which raised to (74.6±12.6) points one year after surgery. The VAS scores, mHHS scores, and iHOT-12 scores of both groups at all postoperative time points showed significant improvement when compared with those preoperative scores (all P<0.05). The observation group demonstrated a greater advantage in alleviating postoperative pain [VAS at one year after the operation: (1.8±1.6) vs (3.1±1.7) points] (P<0.001). In the control group, 3 patients experienced intraoperative complications, specifically involving perforation of the outer edge of the acetabular cortex during anchor placement, resulting in unstable anchor fixation with a success rate of 91.18%(31/34), but in the observation group, no such complications occurred, and the anchor placement success rate was 100%(68/68), it was significantly higher than that in the control group (P=0.049). Both groups of patients healed well postoperatively and were discharged from the hospital successfully. Conclusions: The PA-DALA approach can fulfill the requirements for establishing surgical approaches in hip arthroscopy for common hip diseases. Compared with the conventional DALA approach, the PA-DALA approach enhances the safety and success rate of anchor placement.

[Clinical efficacy of a perineal post-free traction technique in the Trendelenburg position on enhanced recovery following hip arthroscopic surgery in patients with femoroacetabular impingement].

2025-06-12

Jaime Zegarra , Yanyan Wang , Z J Li +5 more | PubMed

Objective: To evaluate the impact of perineal post-free traction in the Trendelenburg position on enhanced recovery after hip arthroscopy in patients with femoroacetabular impingement (FAI). Methods: A retrospective analysis was … Objective: To evaluate the impact of perineal post-free traction in the Trendelenburg position on enhanced recovery after hip arthroscopy in patients with femoroacetabular impingement (FAI). Methods: A retrospective analysis was conducted on patients who underwent hip arthroscopy for FAI at the First Medical Center of the PLA General Hospital between September 2023 and September 2024. Patients were divided into two groups: a control group (traditional traction, n=80) and an enhanced recovery group (Trendelenburg position with perineal post-free traction, n=80). Intraoperative data, including operative time, traction time, Trendelenburg angle, and traction force, were recorded. Clinical outcomes were assessed using the modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12), and the visual analogue scale (VAS) for pain, administered preoperatively and at 3 days and 4 weeks postoperatively. Postoperative limb numbness was evaluated using the numeric rating scale (NRS), VAS scores, and time to resolution. Additional outcomes included the incidence and resolution time of perineal complications, skin injuries, analgesic consumption, length of hospital stay, and patient satisfaction. Results: A total of 160 patients were included, comprising 94 males and 66 females with a mean age of (39.9±14.3) years. The control group included 49 males and 31 females with a mean age (40.5±13.3) years, while the enhanced recovery group included 45 males and 35 females with a mean age of (39.3±15.1) years. No significant differences was observed between the control group and the enhanced recovery group in terms of operative time [(78.73±15.45) vs (79.53±13.28) min] or traction time [(35.50±8.36) vs (37.58±10.66) min] (both P>0.05). At both 3 days and 4 weeks postoperatively, mHHS, iHOT-12 and VAS scores exhibited significant improvement when compared to those preoperative values in both groups (all P<0.001), but with no significant differences between groups (all P>0.05). However, the enhanced recovery group demonstrated significantly better outcomes than the control group in terms of postoperative NRS of numbness [(1.32±0.53) vs (3.22±1.14) points], VAS of numbness [(2.52±1.53) vs (5.51±1.52) points], resolution time of numbness [(2.51±1.52) vs (3.51±1.53) days], incidence of perineal complications [0 vs 5.0%(4/80)], incidence of skin injury [3.8%(3/80) vs 8.8%(7/80)], postoperative analgesic use [(50.25±17.75) vs (75.25±12.25) mg], length of hospital stay [(3.23±0.52) vs (4.23±1.52) days], and patient satisfaction scores [(98.23±1.03) vs (90.12±5.16) points] (all P<0.05). Conclusion: The Trendelenburg position with perineal post-free traction technique provides FAI patients with comparable intraoperative efficacy to traditional traction methods while significantly enhancing postoperative recovery outcomes in patients undergoing hip arthroscopy.

Magnetic Resonance Imaging Characteristics of the Iliocapsularis in Hip Microinstability: A Comparative Analysis

2025-06-12

Yazdan Raji , Kinsley Pierre , Sagar Wagle +3 more | The American Journal of Sports Medicine

Background: Iliocapsularis (IC) muscle hypertrophy in borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) suggests a possible role as a dynamic hip stabilizer. However, … Background: Iliocapsularis (IC) muscle hypertrophy in borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) suggests a possible role as a dynamic hip stabilizer. However, its significance in hip microinstability (MI) without acetabular undercoverage remains unclear. Purpose: To compare IC muscle dimensions and fatty infiltration between patients with MI, BDDH, and mixed-type femoroacetabular impingement (mFAI), and assess the association between IC muscle morphology and hip pathology. Study Design: Case-control study; Level of evidence, 4. Methods: A retrospective analysis was conducted on patients undergoing arthroscopic surgery for hip pathology between January 2014 and December 2022. Patients were categorized based on lateral center-edge angle (LCEA) into BDDH (18° to <25°), MI (25° to 39°), and mFAI (>39°) groups. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed, and IC muscle dimensions, including width, depth, cross-sectional area (CSA), IC fatty infiltration, and combined IC and iliopsoas (IP) (IC+IP) CSA, were measured by 3 independent observers. A priori power analysis was performed. Statistical analyses included parametric and nonparametric comparative tests, interobserver correlation coefficients, and receiver operating characteristic analysis. Results: A total of 95 hips were included in this study. IC depth, width, and CSA and IC+IP CSA were significantly smaller in the MI group ( P < .05 for all). Interobserver agreement was good to excellent for IC width (IRC, 0.87), IC CSA (IRC, 0.87), and IC+IP CSA (IRC, 0.96), but poor for IC depth (IRC, 0.26). The alpha angle did not significantly differ among groups ( P = .093). The MI group had a higher proportion of female patients ( P = .003). No significant differences were noted in radiographic markers, including the ischial spine sign ( P = .083), crossover sign ( P = .130), and posterior wall sign ( P = .41). Conclusion: No detectable IC hypertrophy was observed in the MI group compared with the BDDH and mFAI groups, with patients with MI showing smaller IC width, depth, and CSA. The study offers a reproducible measurement technique with good interobserver agreement. IC muscle mass has limited prognostic value in predicting hip MI.

The Effect of Previous Lumbar Spine Surgery on Primary Hip Arthroscopic Surgery: A Minimum 5-Year Follow-up

2025-06-12

Roger Quesada-Jimenez , Andrew Schab , Ady Kahana-Rojkind +2 more | The American Journal of Sports Medicine

Background: Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands. Purpose: To evaluate the effect of previous LSS on the outcomes … Background: Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands. Purpose: To evaluate the effect of previous LSS on the outcomes of primary hip arthroscopic surgery at a minimum 5-year follow-up. Study Design: Case control; Level of evidence, 4. Methods: A retrospective analysis was conducted on patients who underwent hip arthroscopic surgery with previous LSS. Patients had completed a minimum of 5-year follow-up. A subanalysis based on the type of LSS was also conducted. Patients were matched to a control group that underwent hip arthroscopic surgery without previous LSS in a 1:3 ratio based on age at surgery, sex, acetabular Outerbridge grade, and body mass index. Comparisons of patient-reported outcome (PRO) scores, clinically relevant outcome thresholds, complications, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were performed. Results: A total of 424 hips were included in the study: 106 hips with previous LSS and 318 control hips. Patients with previous LSS displayed improvements across all PRO measures. There were no differences in improvements in PRO scores or the percentage of patients reaching clinically relevant outcome thresholds based on the type of LSS. Compared with the control group, the LSS group started with significantly lower preoperative PRO scores. Yet, both groups experienced equivalent improvements in all PRO scores. Furthermore, the LSS group had worse postoperative scores for all PRO measures. Additionally, the LSS group reached the Patient Acceptable Symptom State at significantly lower rates for the mHHS (modified Harris Hip Score), NAHS (Non-Arthritic Hip Score), and HOS-SSS (Hip Outcome Score–Sports-Specific Subscale). There was no difference in the rates of complications and secondary surgery, but the LSS group converted to THA sooner, with the LSS and control groups converting to THA at 27.43 ± 24.32 and 48.02 ± 37.61 months, respectively ( P < .05). Conclusion: Hip arthroscopic surgery for the treatment of femoroacetabular impingement and labral tears in patients with previous LSS yielded significant improvements at midterm follow-up, which were equivalent to those of a matched control group with no history of lumbar abnormalities. However, the LSS group had lower postoperative PRO scores and met the Patient Acceptable Symptom State for PRO measures at lower rates. Importantly, LSS did not influence the risk of revision arthroscopic surgery and conversion to THA. However, the LSS group converted to THA sooner than the control group.

Ischiopubic Osteochondrosis (Van Neck-Odelberg Disease) as a Rare Cause of Pediatric Hip Pain: A Systematic Review

2025-06-12

Cameron Gerhold , Renish Contractor , Matthew McGee +2 more | Cureus

A cluster-based study on the epidemiology of developmental dysplasia of the hip (DDH) and implication of ultrasonography findings of capsular laxity

2025-06-12

Lee On Ki , Man Yang , Michel Arthur | Journal of Orthopaedics Trauma and Rehabilitation

Introduction Developmental dysplasia of hip (DDH) is a major paediatric musculoskeletal problem that can cause lifelong disability if left untreated. Hong Kong currently adopts universal clinical assessment and selective ultrasound … Introduction Developmental dysplasia of hip (DDH) is a major paediatric musculoskeletal problem that can cause lifelong disability if left untreated. Hong Kong currently adopts universal clinical assessment and selective ultrasound screening. This study aims to obtain a cluster-based epidemiology of DDH and to evaluate the effectiveness of the current screening system. It is also aimed to look for implication of capsular laxity and to propose optimal timing for first ultrasound. Methods Records of children referred to orthopaedics clinic in a major regional hospital for suspected DDH with ultrasound hips performed in 2017–2019 were reviewed. Patient demographics, ultrasound results, treatment and outcome of DDH were reviewed. Results Totally, 929 patients were referred with ultrasound hips done. Twelve of them were diagnosed with DDH. Another 2 patients presented late. The incidence of DDH in 2017–2019 was 0.89/1000 live births and delay diagnosis was 0.13/1000 live births. The open reduction rate was 0.19/1000 live births. Ninety-one patients had capsular laxity and normal follow-up ultrasound. Patients with capsular laxity were significantly younger than those without capsular laxity by Mann–Whitney U test. A statistically significant higher proportion of patients was found to have capsular laxity if first ultrasound was done before 6 weeks old ( p < 0.001). Conclusion The incidence of DDH in the studied cluster is comparable to local study published a decade ago. The current system is justified given the comparable results of late diagnosis and open reduction rate to other developed countries. Purely capsular laxity is benign ultrasonographic finding and 6weeks old is a reasonable time to perform the first ultrasound to prevent overdiagnosis of it.

Performance and return to sport outcomes following hip arthroscopy in National Hockey League players

2025-06-12

David Slawaska‐Eng , Marc Daniel Bouchard , Luigi Del Sordo +2 more | Knee Surgery Sports Traumatology Arthroscopy

Minimum 10-Year Outcomes of Adolescents Undergoing Contemporary Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: A Propensity Score–Matched Analysis

2025-06-12

Richard M. Danilkowicz , Michael Vogel , Omair Kazi +2 more | The American Journal of Sports Medicine

Background: Prior studies have shown that adolescent patients achieve more favorable outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) compared to adult patients at short-term and midterm follow-up, … Background: Prior studies have shown that adolescent patients achieve more favorable outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) compared to adult patients at short-term and midterm follow-up, but a limited number of studies have compared these groups at a minimum 10-year follow-up. Purpose: To compare patient-reported outcome (PRO) scores, achievement rates of clinically significant outcomes, and reoperation-free survivorship between adolescent and adult patients after hip arthroscopic surgery for FAIS at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed on patients who underwent primary contemporary hip arthroscopic surgery for FAIS, including chondrolabral preservation, surgical correction of FAIS, and capsular repair, between January 2012 and November 2013 with a minimum 10-year follow-up. Adolescent patients (aged 10-19 years) were propensity score matched 1:1 to adult patients (aged ≥20 years), controlling for sex, body mass index, Tönnis grade, duration of pain, physical activity status, and back pain. PRO scores were collected preoperatively and at 10-year follow-up, including those for the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. The cohort-specific minimal clinically important difference, Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) were calculated and compared between groups. Reoperation-free survivorship was compared. Results: Overall, 50 adolescent patients (mean age, 17.0 ± 1.7 years) were matched to 50 adult patients (mean age, 33.0 ± 9.3 years) with a mean follow-up of 10.4 ± 0.4 years. No differences in preoperative PRO scores were observed. Adolescents achieved greater 10-year HOS-ADL, HOS-SS, mHHS, iHOT-12, VAS pain, and VAS satisfaction scores compared to adults ( P < .05 for all). Adolescents showed superior achievement rates of the PASS (98% vs 79%, respectively; P = .015) and SCB (88% vs 67%, respectively; P = .035) for any PRO measure compared with adults. No differences in total hip arthroplasty–free survivorship (100% vs 94%, respectively; P = .083) or revision-free survivorship (90% vs 94%, respectively; P = .473) were found. Conclusion: Adolescent patients treated with contemporary hip arthroscopic surgery for FAIS, including chondrolabral preservation, surgical correction of FAIS, and capsular repair, showed superior 10-year PRO scores and achievement rates of the PASS and SCB compared to a propensity score–matched group of adult patients, despite comparable short-term and midterm PROs.

Functional pelvic tilt frequently differs from the anterior pelvic plane in non-arthritic hip disorders

2025-06-06

Mark R. J. Jenkinson , Clement S.K. Cheung , Alastair Dick +2 more | Bone & Joint Open

Aims Hip preservation surgeons are increasingly using commercially available 3D motion analysis software to investigate areas of impingement and quantify femoral head coverage. Variations in functional pelvic tilt will affect … Aims Hip preservation surgeons are increasingly using commercially available 3D motion analysis software to investigate areas of impingement and quantify femoral head coverage. Variations in functional pelvic tilt will affect the position of the acetabular rim and projected femoral head coverage, but currently the majority of available software standardizes sagittal rotation to the anterior pelvic plane (APP). The study hypothesis was that the APP does not correlate well with patient-specific pelvic position. Methods In total, 60 patients were selected from an institutional database: 20 with acetabular retroversion (AR), 20 with developmental dysplasia of the hip (DDH), and 20 with cam-type femoroacetabular impingement (FAI). Multiplanar CT reformats were created and the sagittal rotation was aligned to the APP. The sagittal pelvic orientation was then corrected until the anteroposterior (AP) projection mirrored that of their preoperative supine and standing plain radiographs. The change in sagittal pelvic tilt angle required was measured. Results The mean deviation from the APP in the AR group was 11.55° (SD 4.96°) for supine radiographs and 3.28° (SD 8.66°) for standing radiographs. The mean deviation from the APP in the DDH group was 12.2° (SD 4.26°) for supine radiographs and 6.96° (SD 3.43°) for standing radiographs. The main deviation from the APP in the FAI group was 8.63° (SD 5.21°) for supine radiographs and -1.28° (SD 7.31°) for standing. Conclusion There is a wide variation in patients’ functional pelvic positioning in both supine and standing radiographs, in all different subgroups, which rarely correlates with the APP. Commercial 3D motion analysis may therefore give misleading results for both the extent and location of hip impingement as well as femoral head coverage, which may affect surgical decision-making. Consideration should be given to incorporating this into the software algorithms. Cite this article: Bone Jt Open 2025;6(6):651–657.

Assessing the Risk Factors for Surgical Site and Deep Wound Infections Following Hip Arthroscopy: A Nationwide Study of 75,577 Patients

2025-06-05

Patrick Nian , Adam M. Gordon , Joydeep Baidya +2 more | Journal of the American Academy of Orthopaedic Surgeons

Introduction: The indications and utilization of hip arthroscopic surgery have increased over the past decade owing to advances in surgical technique. Although generally rare, surgical site infections (SSIs) are among … Introduction: The indications and utilization of hip arthroscopic surgery have increased over the past decade owing to advances in surgical technique. Although generally rare, surgical site infections (SSIs) are among the most common postoperative complications following this procedure. This study used a nationwide database to assess the incidence and risk factors for SSIs following arthroscopic hip surgery. Methods: Following a retrospective query of a nationwide administrative claims database for adults (>18 years old) undergoing primary hip arthroscopy from 2010 to 2021, patients were categorized into two cohorts based on whether they did (N = 235) or did not (N = 75,342) develop an SSI within 90 days of surgery. Multivariable logistic regression models were used to calculate odds ratio (OR) of developing SSIs within 90 days following hip arthroscopy, adjusting for age, sex, and comorbidities comprising the Elixhauser Comorbidity Index (ECI). A P value less than 0.05 was considered statistically significant. Results: The overall incidence of SSIs following hip arthroscopy was 0.31%, with no notable change over the study period ( P = 0.697). The two cohorts were similar in age ( P = 0.0716), sex ( P = 0.2959), and geographic location ( P = 0.5995). Overall comorbidity burden was markedly higher among patients who did (ECI = 4.1) versus those who did not (ECI = 2.2) develop SSIs ( P < 0.0001). Risk factors for SSIs following hip arthroscopy included depression (OR: 2.02, P < 0.0001), preoperative fluid and electrolyte abnormalities (OR: 1.81, P = 0.0001), history of drug abuse (OR: 1.74, P = 0.00098), and coagulopathy (OR: 1.58, P = 0.0312). Substratification demonstrated that morbidly obese patients (≥35.00 kg/m 2 ) were more likely to develop SSIs (OR: 4.52, P < 0.0001) compared with patients of normal body mass index. Conclusion: The overall rate of SSIs is low following hip arthroscopy. Certain patient-specific factors may be associated with SSIs and warrant further understanding to prevent these occurrences. This study may guide careful and intentional patient selection and optimization before hip arthroscopy, in efforts to reduce the rate of this event. Level of Evidence: Level III

Hip Microinstability: New Concepts and Comprehensive Imaging Evaluation

2025-06-05