Abnormal Hip Research Articles

Mirror gait retraining for the treatment of patellofemoral pain in female runners

BackgroundAbnormal hip mechanics are often implicated in female runners with patellofemoral pain. We sought to evaluate a simple gait retraining technique, using a full-length mirror, in female runners with patellofemoral pain and abnormal hip mechanics. Transfer of the new motor skill to the untrained tasks of single leg squat and step descent was also evaluated. MethodsTen female runners with patellofemoral pain completed 8 sessions of mirror and verbal feedback on their lower extremity alignment during treadmill running. During the last 4 sessions, mirror and verbal feedback were progressively removed. Hip mechanics were assessed during running gait, a single leg squat and a step descent, both pre- and post-retraining. Subjects returned to their normal running routines and analyses were repeated at 1-month and 3-month post-retraining. Data were analyzed via repeated measures analysis of variance. FindingsSubjects reduced peaks of hip adduction, contralateral pelvic drop, and hip abduction moment during running (P<0.05, effect size=0.69–2.91). Skill transfer to single leg squatting and step descent was noted (P<0.05, effect size=0.91–1.35). At 1 and 3months post retraining, most mechanics were maintained in the absence of continued feedback. Subjects reported improvements in pain and function (P<0.05, effect size=3.81–7.61) and maintained through 3months post retraining. InterpretationMirror gait retraining was effective in improving mechanics and measures of pain and function. Skill transfer to the untrained tasks of squatting and step descent indicated that a higher level of motor learning had occurred. Extended follow-up is needed to determine the long term efficacy of this treatment.

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool. We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra- and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model. We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model. Intra- and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum. Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges. Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

T2* Mapping of Acetabular and Femoral Hip Joint Cartilage at 3 T

The aim of this study was to identify the pattern of T2* values in acetabular and femoral head cartilage in morphologically normal and abnormal zones at 3 T. Twenty-nine patients (mean [SD] age, 30.8 [8.8] years) with symptomatic femoroacetabular impingement and suspected cartilage damage (study group) and 35 healthy, asymptomatic volunteers (mean [SD] age, 24.9 [2.1] years) with no obvious history of hip diseases or abnormalities (control group) were included. Magnetic resonance imaging was performed at 3 T using a 3-dimensional (3D) double-echo steady-state sequence for grading cartilage morphologically and a 3D multiecho data image combination sequence for T2* assessment. Statistical assessment included the Student t test to reveal differences between mean T2* values of the study group and the control group. One-way analysis of variance was used to identify any statistically significant differences between the T2* values in various grades (modified Outerbridge score system) of cartilage damage within the study group. Significant differences were noted between the T2* values in the study group and the control group (P < 0.001). We also noted a significant drop in T2* in accordance with the morphologic damage in the study group (P < 0.001). The largest drop in T2* was found between morphologically normal-appearing cartilage (grade 0; T2*, 25.2 milliseconds) and grade I changes (T2*, 18.1 milliseconds) (P < 0.001). In combination with a 3-T system, T2* mapping offers unique advantages such as high image resolution and the ability of 3D biochemically sensitive cartilage evaluation in the hip joint without the need for contrast medium. Given these advantages, we believe that T2* mapping is another welcome addition to the rapidly evolving era of hip cartilage biochemical imaging. Further studies are necessary that involve a diagnostic histological analysis as gold standard for comparison.

The effect of pain on hip and knee kinematics during running in females with chronic patellofemoral pain

PurposeDespite the growing recognition of the role of abnormal hip and knee mechanics in patellofemoral pain (PFP), few studies have assessed if or how these mechanics change when the person experiences pain while running. Therefore, the purpose of this study was to determine if the development of pain while running resulted in altered hip and knee kinematics in female runners with PFP as compared to healthy female runners. MethodsThirty female runners (15 PFP, 15 controls) participated in an instrumented gait analysis while running for 30min at a self-selected pace. Pain and fatigue were recorded every minute while participants ran. Variables of interest included peak hip adduction, hip internal rotation, knee abduction, knee external rotation, pain, and fatigue. ResultsThere were significant group by pain interactions for hip adduction (p<0.01) and hip internal rotation (p<0.01). The healthy group, who did not develop pain had significant increases in both motions compared to the PFP group, who did develop pain. There was also a trend toward less knee external rotation in the PFP group in presence of pain (p=0.059). No differences were found for knee abduction (p=0.32). A group main effect was found for hip internal rotation (p=0.008) in which the PFP group had significantly larger values. ConclusionRunners with PFP did not alter their hip mechanics over the course of the run. This may have resulted in repetitive stress to the same aspect of the patellofemoral joint and contributed to the initial development of pain. However, the PFP group did attempt to make a compensation once in pain by reducing knee external rotation.

The Biomechanical Case for Labral Débridement

Labral repair is increasingly performed in conjunction with open and arthroscopic surgical procedures used to treat patients with mechanically related hip pain. The current rationale for labral repair is based on restoring the suction-seal function and clinical reports suggesting improved clinical outcome scores when acetabular rim trimming is accompanied by labral repair. However, it is unclear whether available scientific evidence supports routine labral repair. The questions raised in this review were: (1) does labral repair restore normal histologic structure, tissue permeability, hip hydrodynamics, load transfer, and in vivo kinematics; and (2) does labral repair favorably alter the natural course of femoroacetabular impingement (FAI) treatment or age-related degeneration of the acetabular labrum? An electronic literature search for the keywords acetabular labrum was performed. Three hundred fifty-five abstracts were reviewed and 52 selected for full-text review that described information concerning pertinent aspects of labral formation, development, degeneration, biomechanics, and clinical results of labral repair or resection. Several clinical studies support labral repair when performed in conjunction with acetabular rim trimming. Little data support or refute the use of routine labral repair for all patients with symptomatic labral damage associated with FAI. It is not known whether or how labral repair affects the natural course of FAI. Based on the current understanding of labral degenerative changes associated with mechanical hip abnormalities, the low biologic likelihood of restoring normal tissue characteristics, and mechanical data suggesting minimal consequence from small labral resections, routine labral repair over labral débridement is not supported.

Defining the normal acetabular vault in adult males and females using a novel three‐dimensional model

The management and quantification of bone loss is a major challenge in primary and revision total hip replacement. Defining the normal three-dimensional (3D) anatomy of the acetabular vault could aid in assessing pathologic changes and in designing prosthetic joint components. We performed a quantitative assessment of normal 3D acetabular vault structure to define the shape and location of weight-bearing acetabular bone referred to as the vault. Images from 70 normal hip computed tomography images were used to define the 3D acetabular vault anatomy and develop a 3D model. Variation in vault shape was quantified by measuring the distance between every surface point on a subject's hemipelvis and the reference vault. Variation among different hip alignments was assessed using 19 scans from subjects with varus, valgus and dysplastic hip morphologies. The acetabular vault model had 96.6% (95% CI: 91.7-101.5), 97.8% (95% CI: 94.5-101.1) and 96.4% (95% CI: 98.7-94.1) of the surface points within 3 mm of normal male, normal female and abnormal hip specimens, respectively. Comparison of acetabular vault model fit between gender and hip types revealed that it was only significantly different between normal males and normal females (P = 0.0194) and between normal males and dysplastic females (P = 0.0377). A conserved 3D acetabular vault shape and location exists that can accommodate various hip morphologies. Defining a normal vault may increase the precision with which hip pathology can be identified and may also serve as a preoperative assessment tool for planning total hip arthroplasty.

Paper 37: Prevalence of Abnormal Hip Findings in Asymptomatic Subjects: A Prospective Blinded Study

Paper 37: Prevalence of Abnormal Hip Findings in Asymptomatic Subjects: A Prospective Blinded Study

Is There a Higher Prevalence of Radiographic Abnormalities of the Hip in Elite Soccer Players?

Is There a Higher Prevalence of Radiographic Abnormalities of the Hip in Elite Soccer Players?

Identification of Acetabular Labral Pathological Changes in Asymptomatic Volunteers Using Optimized, Noncontrast 1.5-T Magnetic Resonance Imaging

Background: Acetabular labral tears as a source of potential hip pain have received a great deal of attention in recent literature. The gold standard for identifying acetabular labral tears is hip arthroscopy, but recent advances in optimized, noncontrast magnetic resonance imaging (MRI) have proven effectiveness in identifying intra-articular hip pathological changes without the invasive nature of hip arthroscopy or gadolinium-enhanced arthrography. There are little data in the literature on imaging results in an asymptomatic population. Purpose: The objective of this study was to use an optimized, noncontrast 1.5-T MRI protocol to identify hip abnormalities, including paralabral cysts, in asymptomatic volunteers. Study Design: Case series (prevalence); Level of evidence, 4. Methods: In this study, 42 hips in asymptomatic patients with an average age of 34 years (range, 27-43 years) were prospectively imaged with optimized, noncontrast 1.5-T MRI scans. Two fellowship-trained musculoskeletal radiologists interpreted the scans at 2 different points in time and commented on the presence of labral abnormalities including paralabral cysts. The results were analyzed for both interobserver and intraobserver reliability. Results: Acetabular paralabral cysts were identified in 11 of 42 (26.2%) and 9 of 42 (21.4%) hips by the 2 respective radiologists, with an interobserver reliability of 90.5% (κ = .74) and intraobserver reliability of 95.2% (κ = .87). In addition, acetabular labral tears were identified in 36 of 42 (85.7%) and 34 of 42 (80.9%) hips, with an interobserver reliability of 90.5% (κ = .70) and intraobserver reliability of 95.2% (κ = .83). Conclusion: Utilizing an optimized, noncontrast 1.5-T MRI protocol, we report the previously undescribed prevalence of acetabular labral pathological abnormalities and paralabral cysts in a young, asymptomatic population. This emphasizes the importance of correlating patient symptoms with history and physical examination when evaluating patients with hip pain and radiographic abnormalities as defined by MRI criteria. These data demonstrate that labral tears can occur without symptoms.

The Epiphyseal Torsion Angle in MR Arthrography of the Hip: Diagnostic Utility in Patients With Femoroacetabular Impingement Syndrome

The purpose of the study was to evaluate whether patients with clinically suspected femoroacetabular impingement (FAI) show higher epiphyseal torsion angle values on MR arthrography than healthy volunteers. Another objective was to estimate whether patients with increased epiphyseal torsion angles show a higher incidence of hip abnormalities or a higher incidence of increased alpha angles on MR arthrography than patients with an epiphyseal torsion angle considered normal. Sixty-eight consecutive patients with clinically suspected FAI, no history of hip surgery, and MR arthrography of the hip performed at our institution were included in the study group. The control group included 50 standard MR examinations of the hip of 25 healthy volunteers with negative findings on a clinical impingement test. Epiphyseal torsion angles and alpha angles were measured independently by three radiologists. Furthermore, MR arthrograms were retrospectively evaluated by two radiologists in consensus for hip abnormalities associated with FAI. The epiphyseal torsion angles were significantly higher in the study group than the control group for all three readers (reader 1, p = 0.001; reader 2, p = 0.003; reader 3, p = 0.045). There was no statistical correlation between increased epiphyseal torsion angles and pathologic alpha angles (readers 1-3: p = 0.199, p = 0.343, p = 0.058, respectively). Patients with increased epiphyseal torsion angles did not show a higher incidence of labral abnormalities than patients with epiphyseal torsion angles considered normal (readers 1-3: p = 0.335, p = 0.383, p = 0.676). Patients with clinically suspected FAI show increased epiphyseal torsion angles compared with healthy volunteers. Values greater than 20° should be considered pathologic. A pathologic retrotorsion of the femoral epiphysis may play a role in developing hip pain related to FAI and premature osteoarthritis.

The Prevalence of Radiographic Hip Abnormalities in Elite Soccer Players

Background: Hip injuries, both intra- and extra-articular, are becoming a more commonly recognized, diagnosed, and treated injury in athletes of all competitive levels. Our goal is to establish a previously undefined value in this athletic population—the prevalence of radiographic hip abnormalities in elite soccer athletes. Purpose: To provide a foundation for the future body of literature regarding hip pathologic abnormalities and “at-risk” hips in athletes of all ages and levels of participation. Study Design: Descriptive epidemiology study. Methods: We retrospectively reviewed the anteroposterior pelvis and frog-leg lateral radiographs of 95 elite male and female soccer players to determine the prevalence of hip abnormalities. Athletes with a history of hip or groin injuries were included. Multiple radiographic parameters were used to assess the presence of cam and pincer-type femoroacetabular impingement. Measurements were conducted by a blinded, sports medicine fellowship–trained orthopaedic surgeon with experience in treating hip disorders. Results: In total, 72% (54/75) of male and 50% (10/20) of female players demonstrated some evidence of radiographic hip abnormality. Cam lesions were present in 68% (51/75) of men (76.5% [39/51] bilateral involvement) and 50% (10/20) of women (90% [9/10] bilateral involvement). Pincer lesions were present in 26.7% (20/75) of men and 10% (2/20) of women. The average male alpha angle overall was 65.6°. Cam-positive hips averaged 70.7°. The average female alpha angle overall was 52.9°, with cam-positive hips averaging 60.8°. Conclusion: The prevalence of radiographic hip abnormalities in elite soccer athletes is considerable, particularly in young male athletes. The establishment of the prevalence of these findings represents the first step in identifying the relationship between radiographic abnormalities and injuries of the hip and groin in athletes.

Simultaneous bilateral hip joint imaging at 7 Tesla using fast transmit B₁ shimming methods and multichannel transmission - a feasibility study.

The objective of this study was to demonstrate the feasibility of simultaneous bilateral hip imaging at 7 Tesla. Hip joint MRI becomes clinically critical since recent advances have made hip arthroscopy an efficacious approach to treat a variety of early hip diseases. The success of these treatments requires a reliable and accurate diagnosis of intraarticular abnormalities at an early stage. Articular cartilage assessment is especially important to guide surgical decisions but is difficult to achieve with current MR methods. Because of gains in tissue contrast and spatial resolution reported at ultra high magnetic fields, there are strong expectations that imaging the hip joint at 7 Tesla will improve diagnostic accuracy. Furthermore, there is growing evidence that the majority of these hip abnormalities occur bilaterally, emphasizing the need for bilateral imaging. However, obtaining high quality images in the human torso, in particular of both hips simultaneously, must overcome a major challenge arising from the damped traveling wave behaviour of RF waves at 7 Tesla that leads to severe inhomogeneities in transmit B1 (B(1) (+) ) phase and magnitude, typically resulting in areas of low signal and contrast, and consequently impairing use for clinical applications. To overcome this problem, a 16-channel stripline transceiver RF coil was used, together with a B1 shimming algorithm aiming at maximizing B(1) (+) in six regions of interest over the hips that were identified on axial scout images. Our successful results demonstrate that this approach effectively reduces inhomogeneities observed before B1 shimming and provides high joint tissue contrast in both hips while reducing the required RF power. Critical to this success was a fast small flip angle B(1) (+) calibration scan that permitted the computation of subject-specific B1 shimming solutions, a necessary step to account for large spatial variations in B(1) (+) phase observed in different subjects.

Etiology of osteoarthritis: genetics and synovial joint development

Osteoarthritis (OA) has a considerable hereditary component and is considered to be a polygenic disease. Data derived from genetic analyses and genome-wide screening of individuals with this disease have revealed a surprising trend: genes associated with OA tend to be related to the process of synovial joint development. Mutations in these genes might directly cause OA. In addition, they could also determine the age at which OA becomes apparent, the joint sites involved, the severity of the disease and how rapidly it progresses. In this Review, I propose that genetic mutations associated with OA can be placed on a continuum. Early-onset OA is caused by mutations in matrix molecules often associated with chondrodysplasias, whereas less destructive structural abnormalities or mutations confer increased susceptibility to injury or malalignment that can result in middle-age onset. Finally, mutations in molecules that regulate subtle aspects of joint development and structure lead to late-onset OA. In this Review, I discuss the genetics of OA in general, but focus on the potential effect of genetic mutations associated with OA on joint structure, the role of joint structure in the development of OA--using hip abnormalities as a model--and how understanding the etiology of the disease could influence treatment.

Morphometric assessment of the hip joint in the Estrela Mountain Dog breed

To study the radiographic projected hip parameters of the proximal femur and acetabulum in young and adult Estrela Mountain Dogs with normal and abnormal hip joints. The parameters evaluated were: femoral angles of inclination and anteversion (FAI and FAA), femoral neck length and width (FNL and FNW), acetabular depth (AD) and acetabular angle of retrotorsion (AAR). Five hundred and twenty-five standard hip-extended ventrodorsal radiographic views and 622 mediolateral views of the right and left femur were used to measure the FAI, FAA, FNL, FNW, AD, AAR and modified AAR (mAAR). The FAI decreased in adult dysplastic dogs, in females and in right femora; FAA decreased with age; FNL was characterized by a greater relative size in normal adult animals; FNW was greater in abnormal hips in young and adult animals; AD was less in adult dysplastic dogs and in right hips; AAR was similar in the studied groups; mAAR was greater in abnormal hips and in left hips. The data may be used in future studies, which compare this breed to others. Morphological variations in femoral neck and acetabular morphometric parameters were present, and these variables in dogs with different ages and with hips in varying states of health should not be compared.

Osteonecrosis and Leg Ulceration in Indian Sickle Cell Patients

Sir, Avascular necrosis of bone and cutaneous leg ulcers are the most common manifestation of patients with sickle cell disease (SCD) [1, 2]. The bone areas most frequently affected are cortical bone of the acetabulum, head of the femur, and head of the humerus. Osteonecrosis of the femoral head is common in patients with sickle cell disease. The hip and shoulder abnormalities are also seen in patients. Multifocal osteonecrosis is defined as disease of 3 or more anatomic sites. Patients diagnosed with osteonecrosis of the knee, shoulder and ankle should be evaluated for other joints for osteonecrosis. In patients with sickle cell disease, clinical complications including osteonecrosis can vary in frequency and severity, presumably due to the effects of genes that modify the pathophysiology initiated by the sickle mutation [3]. Baldwin et al. suggested genetic influence of BMP6 and ANXA2 SNPs with osteonecrosis in SCD [3]. The incidence of leg ulcers in patients with SCD ranges from 25.7% to 75% [4, 5]. Leg ulcers are a common sub-phenotype of sickle cell disease. Their cause is unknown, their prevention is impractical and their management, once present, is often difficult. Leg ulceration and avascular necrosis (AVN) in SCD has become serious problem in a few decades in India, however the incidence of leg ulcer and AVN in sickle cell patients has not been studied extensively in India till date. We had 150 sickle cell patients (60 sickle cell anemia, 75 sickle β-thalassemia and 15 sickle hemoglobin D) recruited from out patient department hematology AIIMS, New Delhi, India. Study period was 3 y. Signed consent form taken from all the patient and study was approved by institutional ethical committee. Diagnosis of patients was done by high performance liquid chromatography (Bio-Rad-VariantTMBio Rad, CA, USA). Complete blood count and red cell indices were measured by automated cell analyzer (SYSMEXK-4500, Kobe Japan). Osteonecrosis screening was done by X-ray and confirmation was done by magnetic resonance imaging (MRI) while leg ulceration was reported on physical examination. MRI is the most sensitive means of diagnosing AVN. MRI facilitates better response to treatment because with the use of MRI, avascular necrosis is diagnosed at an earlier stage and therapeutic measures are more successful the earlier they are begun. Out of 150 cases 14 (8 boys and 6 girls with mean age; 11.5±3.4 y) presented with osteonecrosis where seven were from HbSS, 6 from sickle beta thalassemia and one fromHbSD patients. Nine patients presented with femoral head ( 5 HbSS and 4 HbSβ-thal) while 3 hip (2 HbSS and 1HbSD) and 2 (HbSβ-thal)with shoulder osteonecrosis. Seven patients (4 boys and 3 girls with mean age; 12.3±2.6 y) presented with leg ulceration out of 150 SCD patients (5HbSS and 2 HbSβ-thal). None of the patients presented both complications i.e., leg ulceration and AVN together. Observation of the study concludes the increased risk of AVN (9.34%) and leg ulceration (4.67%) in Indian sickle cell patients where alpha thalassemia and high HbF is prevalent in patients.

Association between cam-type deformities and magnetic resonance imaging-detected structural hip damage: A cross-sectional study in young men

Femoroacetabular impingement may be a risk factor for hip osteoarthritis in men. An underlying hip deformity of the cam type is common in asymptomatic men with nondysplastic hips. This study was undertaken to examine whether hip deformities of the cam type are associated with signs of hip abnormality, including labral lesions and articular cartilage damage, detectable on magnetic resonance imaging (MRI). In this cross-sectional, population-based study in asymptomatic young men, 1,080 subjects underwent clinical examination and completed a self-report questionnaire. Of these subjects, 244 asymptomatic men with a mean age of 19.9 years underwent MRI. All MRIs were read for cam-type deformities, labral lesions, cartilage thickness, and impingement pits. The relationship between cam-type deformities and signs of joint damage were examined using logistic regression models adjusted for age and body mass index. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined. Sixty-seven definite cam-type deformities were detected. These deformities were associated with labral lesions (adjusted OR 2.77 [95% CI 1.31, 5.87]), impingement pits (adjusted OR 2.9 [95% CI 1.43, 5.93]), and labral deformities (adjusted OR 2.45 [95% CI 1.06, 5.66]). The adjusted mean difference in combined anterosuperior femoral and acetabular cartilage thickness was -0.19 mm (95% CI -0.41, 0.02) lower in those with cam-type deformities compared to those without. Our findings indicate that the presence of a cam-type deformity is associated with MRI-detected hip damage in asymptomatic young men.

Aplasia of the mandibular condyle associated with some orthopaedic abnormalities

A rare case of aplasia of mandibular condyle associated with some other orthopaedic problems is presented. A 5-year-old boy attended our clinic with a chief complaint of facial asymmetry and chewing difficulty. The mandible was deviated to the left. The occlusion also showed a deflection to the left of the mandibular midline. He also had walking difficulty owing to a hip abnormality. Panoramic radiographic examination of the patient revealed that the left mandibular condyl was totally absent. The right condyle was unremarkable. His history revealed neither trauma nor any significant disease. Aplasia is a rare anomaly and means the insufficient development of the mandibular condyle. True agnesis of the mandibular condyle is extremely rare. Association of the manifestations of the patient with some orthopaedic problems makes this case interesting.

Proximal and distal kinematics in female runners with patellofemoral pain

BackgroundFemale runners have a high incidence of developing patellofemoral pain. Abnormal mechanics are thought to be an important contributing factor to patellofemoral pain. However, the contribution of abnormal trunk, hip, and foot mechanics to the development of patellofemoral pain within this cohort remains elusive. Therefore the aim of this study was to determine if significant differences during running exist in hip, trunk and foot kinematics between females with and without patellofemoral pain. Methods32 female runners (16 patellofemoral pain, 16 healthy control) participated in this study. All individuals underwent an instrumented gait analysis. Between-group comparisons were made for hip adduction, hip internal rotation, contra-lateral pelvic drop, contra-lateral trunk lean, rearfoot eversion, tibial internal rotation, as well as forefoot dorsiflexion and abduction FindingsThe patellofemoral pain group had significantly greater peak hip adduction and hip internal rotation. No differences in contra-lateral pelvic drop were found. A trend towards reduced contra-lateral trunk lean was found in the patellofemoral pain group. No significant differences were found in any of the rearfoot or forefoot variables but significantly greater shank internal rotation was found in the patellofemoral pain group. InterpretationWe found greater hip adduction, hip internal rotation and shank internal rotation in female runners with patellofemoral pain. We also found less contra-lateral trunk lean in the patellofemoral pain group. This may be a potential compensatory mechanism for the poor hip control seen. Rehabilitation programs that correct abnormal hip and shank kinematics are warranted in this population.

Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement have been recently implicated as risk factors for hip OA. The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search with PubMed, Embase, and CENTRAL was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case-control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and femoroacetabular impingement and hip OA, and preliminary evidence suggests that AD is a risk factor for OA; however, these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA.

Intraocular pressure and cataract among obese adults in Benin City

Obesity is a leading preventable cause of death worldwide with increasing prevalence in adult and children. Authorities view it as the number one most serious public health problem of the 21st Century. It has been shown that obesity puts people at increased risk of at least four major blinding diseases. The risk of age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma can be increased in individuals either through the presence of obesity related systemic diseases such as diabetes or directly due to a high body mass index (BMI) abnormal circumference or waist hip ratio. This study was a cross sectional study. The sample size consisted of a total of 80 subjects, 40 obese (BMI = 30kg/m2) and 40 lean (BMI &lt; 30kg/m2), between the ages of 65 75 (mean age 64.20&plusmn;2.25). The subjects were divided into two groups, group 1(the obese) and group 2 (the lean) which acted as control group. This study showed a positive correlation between BMI and IOP p&lt;0.01. There was also a statistically significant correlation between BMI and the cup to disc (C/D) ratio p&lt;0.01. There was no correlation between BMI and cataract among the population studied.Keywords: Obesity, Intraocular pressure, Cataract, Glaucoma.