Intra- and periarticular hip anatomy through the arthroscope

Fractures of the femoral head (FFH) are mainly seen in young adults, and the majority mechanism is due to dashboard injury in crushing vehicles. FFH can be present with or without posterior dislocation of the hip joint. Except for periarticular pain and hip dysfunction, the typical signs include flexion, adduction and internal rotation of the hip and shortening of involved limb. CT and MRI get their popularity as diagnostic methods for FFH. An emergency open reduction should be indicated in the scenario of failed closed reduction in FFH with posterior dislocation, of FFH with femoral neck fractures, of unmatched head and acetabulum following closed reduction and of deteriorating sciatic nerve damage. Pipkin as well as Brumback classification is still the most popularly used methods, which have great significance for establishment of surgical strategy and prediction of prognosis. More and more clinical evidences show conservative care of FFH should only be indicated for non-displaced fractures or displacement less than 2 mm. These cases must meet the following criteria simultaneously, including stable hip joint, concentric head and acetabulum, no free fractured fragments in the joint space and no labrum entrapment. Operative care is naturally the treatment of choice. Surgical approaches for FFH are hot topics in recent years. In previous control studies to compare Kocher-Langenbeck (K-L) and Smith-Peterson (S-P) approach, it is revealed less operative time, less blood loss and better operative field you can get in S-P approach, however, the incidence of ectopic ossification is higher. Ganz approach, which is characterized by osteotomy of great trochanter, hip capsulotomy and surgical dislocation of the hip, is a novel pattern for operative care of FFH. Ganz approach can show the entire femoral head, while can not damage medial femoral circumflex artery (MFCA) and induce iatrogenic osteonecrosis of the femoral head (ONFH). Various screws are the main implants for the fixation of fractured femoral head. Osteoarthritis and ONFH are two principal complications following FFH, which not only closely associate with severity and mechanism of primary injury, but also correlate with reduction quality and iatrogenic factors. Artificial hip joint replacement is a rational choice for extremely comminuted femoral head and these FFH in the elderly.

PurposeSnapping hip is a common clinical condition, characterized by an audible or palpable snap of the hip joint. When the snap is perceived at the lateral side of the hip, this condition is known as external snapping hip or lateral coxa saltans, which is usually asymptomatic. Snapping hip syndrome (SHS) refers to a painful snap, which is more common in athletes who require increased hip range of motion. The aim of this article is to review the most common endoscopic techniques for the treatment of ESHS, as well as their results and limitations.MethodsThis is a review of the current literature of endoscopic surgical procedures and of the results of the treatment of external snapping hip syndrome.ResultsThe pathogenesis of SHS is mechanical. The initial treatment attempt is conservative, and usually provides good results. Patients who do not respond to conservative management are candidate for surgery. The endoscopic release of the ilio-tibial band or the endoscopic release of the femoral insertion of the gluteus maximum tendon is the most popular technique.ConclusionEndoscopic techniques provide fewer complications compared to open surgery, a lower recurrence rate and good clinical outcomes. More comparative studies with a longer follow-up are required to adequate evaluate the full role of endoscopic techniques in periarticular hip surgery.Level of evidenceLevel V.

The authors report a patient with neuropathy of inferior gluteal and pudendal nerves following periarticular synovial cyst of the hip joint. Effectiveness of treatment was analyzed. ENMG and MRI of pelvic soft tissues and hip joint were applied to confirm neuropathy of inferior gluteal and genital nerves. Periarticular synovial cyst of the hip joint followed by compression and ischemia of inferior gluteal and pudendal nerves was detected. In pre- and postoperative period, intensity of pain syndrome was assessed using visual-analogue scale. Neuropathic pain and quality of life were evaluated using the Leeds scale (LANSS) and NeuroQoL questionnaire, respectively. The patient underwent microsurgical neurolysis and decompression of inferior gluteal and pudendal nerves and resection of periarticular synovial cyst of the hip joint. Complete regression of pain syndrome and improvement in quality of life were observed after surgery. Compression of neurovascular structures with periarticular hip cysts followed by clinical and neurological disorders is an indication for microsurgical neurolysis and resection of cyst.

To determine clinical characteristics in children with osteogenesis imperfecta (OI) regarding impairment (range of joint motion and muscle strength) and disability (functional skills) in relation to the different types of the disease, and to study the correlation between characteristics of impairment and disability. In a cross-sectional study 54 children with OI (OI type I: 24; OI type III: 15; OI type IV: 15), the range of joint motion, muscle strength, and functional ability were measured in a standardized way and analyzed statistically. The range of joint motion in almost all joints differed significantly with respect to the different disease types. In OI type I patients, generalized hypermobility of the joints was present, without decrease in joint motion. In OI type III the extremities were severely maligned, especially the lower limbs. In type IV the upper and lower extremities were equally maligned. Muscle strength differed significantly with respect to the different types of OI. In type I patients, muscle strength was normal except for the periarticular hip muscles. In type III, especially in the lower extremities, muscle strength was severely decreased, with a muscular imbalance around the hip joint. In type IV, muscle strength was mainly decreased in the proximal muscles of the upper and lower extremities. In children </=7.5 years of age, significant differences existed among the different disease types in functional skills regarding mobility. No significant difference was observed in self-care and social function, although the most severely affected children showed a tendency to score better with social function. Older children differed significantly concerning mobility and self-care items. In children </=7.5 years old, a correlation was sometimes observed between impairment and disability items, although in older children a moderate to good correlation was always present (r > .6). In OI, severity-related profiles exist, within the different subtypes of the disease, regarding range of joint motion, muscle strength, and functional skills. In younger children, impairment parameters do not sufficiently correlate for disability. Rehabilitation strategies in younger children should therefore focus on improvement of functional skills and not only on impairment parameters.

Postpartum periarticular hip abscess with later coxitis caused by group B streptococcus

Relación entre medidas radiológicas y morfología de cadera en individuos con parálisis cerebral: serie de casos

Pruebas de imagen y evaluación de la patología articular y periarticular de la cadera

Management of subacute acetabular osteomyelitis in a child

Articular and peri-articular hip lesions in soccer players. The importance of imaging in deciding which lesions will need surgery and which can be treated conservatively?

BackgroundTotal hip arthroplasty is the gold standard for treatment of hip osteoarthritis. The different surgical approaches utilize different intervals to access the hip joint. There is concern that some surgical approaches cause soft tissue trauma resulting in post-operative muscle weakness of patients undergoing THA. We therefore asked whether the implantation of a total hip prosthesis by each of four common surgical approaches (anterior, anterolateral, direct lateral and posterior) leads to (i) muscle atrophy (defined as decreased muscle cross-sectional area [CSA]) and (ii) muscle degeneration (defined as fatty infiltration) of 12 specific periarticular hip muscles. Further, if significant change is found, can we establish an associated pattern with a particular surgical approach?MethodWe retrospectively evaluated 493 patients undergoing computed tomography of the pelvis in HFR hospital Fribourg, Switzerland, between 2014 and 2020. All patients had undergone a primary THA at some point prior to their CT scan. Trauma, metastasis, bone tumor, neurologic disorder, infection, and revision cases were excluded. Twelve periarticular hip muscles were measured for CSA and degree of fatty infiltration according to the Goutallier scale on axial and sagittal views of both the operative and nonoperative hips.ResultsCSA of the operative hip muscles differed significantly depending on approach. Similarly, there was a statistically significant difference in muscle degeneration in the operative hips according to the Goutallier classification. We observed a specific level and pattern of muscle atrophy for each approach.ConclusionIn all approaches, there is a trade-off between the muscles they affect, their role, and whether there is a possibility of partial compensation by other muscles. The anterior approach was the least harmful to the gluteus medius muscle.