Abnormal Hip Research Articles

Short-term Effect of Ultrasound-Guided Iliopsoas Peritendinous Corticosteroid Injection.

Treatment for iliopsoas tendinopathy includes ultrasound (US)-guided iliopsoas peritendinous corticosteroid injection. Evidence is lacking regarding US-guided iliopsoas injection efficacy in patients with iliopsoas tendinopathy and intra-articular (IA) hip abnormalities. The purpose of this study was to examine the efficacy of US-guided iliopsoas corticosteroid injection for iliopsoas tendinopathy in patients with and without IA hip abnormalities. This work was a prospective study evaluating patients aged 12 to 50 years with iliopsoas tendinopathy. Participants completed a Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire before and 6 weeks after injection. The main outcome measure was the change in HOOS subcategory scores. Independent variables included time and hip status. Normal hips were compared to abnormal hips with IA abnormalities. A 2-way repeated measures analysis of covariance with effect size (η2 ) was used to determine injection effects on HOOS scores before and 6 weeks after injection. A total of 178 patients (154 female and 24 male) were analyzed. Time effects were found for both normal and abnormal hips in all HOOS subcategories: symptoms (P = .041; η2 = 0.050), pain (P = .001; η2 = 0.184), activities of daily living (P = .011; η2 = 0.076), function in sports and recreation (P = .001; η2 = 0.151), and quality of life (QOL; P = .001; η2 = 0.193). Significant differences between normal versus abnormal hips were found in the sports and recreation (P = .032; η2 = 0.056) and QOL scores (P = .001; η2 = 0.135). In patients with iliopsoas tendinopathy, US-guided iliopsoas corticosteroid injection improved outcomes regardless of coexisting IA hip abnormalities. Patients without IA hip abnormalities showed greater improvement in sports and recreation and QOL scores compared to patients with IA hip abnormalities. Ultrasound-guided iliopsoas injection for iliopsoas tendinopathy may advance short-term care and help continue with nonsurgical treatment regimens.

The 'low-volume acetabulum': dysplasia in disguise.

ABSTRACTAlthough there are well described radiological criteria for diagnosing DDH, our experience has highlighted that a new sub-category of hips exists in which the classic radiographic characteristics for DDH may be normal but the coverage of the femoral head is compromised. The purpose of this study was to validate a simple radiographic measurement method for calculating the depth of the acetabulum in order to detect individuals with ‘low-volume’ acetabuli and under-covered femoral heads. We identified 24 patients who were suspected of having low-volume acetabuli and compared their radiographs with those of 150 patients with non-dysplastic hips. The radiographic indices measured included the lateral center-edge (CE) angle, the anterior CE angle, the femoral neck-shaft angle, the extrusion index, integrity of the Shenton’s line, the crossover sign, and ischial spine sign. We have developed a novel, but a simple method, named the ‘coverage index’ (CI) to identify the presence of a low-volume acetabulum on plain radiographs. Comparisons were made between the low-volume hips and the non-dysplastic hips. The radiographic parameters indicative of developmental dysplasia of the hip (DDH) were within normal limits in all patients with low-volume acetabuli and therefore these hips could not be classified as ‘dysplastic’ based on the traditional radiological parameters. There was no difference between the mean radius of the femoral head in two groups. The mean CI was significantly greater in the non-dysplastic group compared with the low-volume acetabula cohort (1.62 ± 0.117 in non-dysplastic group versus 1.07 ± 0.11 in low-volume hips) (P = 0.0001). Orthopaedic surgeons should be aware of a hip abnormality in which the femoral head coverage is deficient, yet all the conventional parameters for measuring coverage, including the center edge angle, are within normal limits. We have introduced a simple radiographic measurement method that may help surgeons identify these patients using the anteroposterior radiographs of the hip.

CLINICAL AND ROENTGENOLOGICAL CRITERIA OF SPINE-PELVIS RATIOS IN CHILDREN WITH DYSPLASTIC FEMUR SUBLUXATION

Aim of the study — to identify clinical and roentgenological criteria of the sagittal profile status of spine-pelvis segment in children with dysplastic femur subluxation.Material and Methods. The present study included 40 female patients (50 hip joints) aged from 12 to 17 years (14.7±1.58) with unilateral and bilateral hip joint instability due to dysplasia. Children were divided into two groups – the first group included 30 patients (30 hip joints) with unilateral femur subluxation, the second group – 10 patients (20 hip joints) with bilateral femur subluxation. All patients underwent a standard orthopaedic clinical examination using a specialized scale to objectify complaints. All patients underwent X-ray examination of hip joints in AP and Lauenstein projections, CT scanning as well as lateral panoramic roentgenography of C1-S1 including femoral bones in standing position of the patient.Results. The authors observed a strong positive correlation between sacrum inclination and lumbar lordosis curvature, antetorsion angle of proximal femur and sacrum inclination angle, severity of pain syndrome during impingement test and sacrum tilt: Pearson correlation coefficient was 0.71, 0.81 and 0.88 respectively. The authors reported in all patients a thoracic normokyphosis and lumbar hyperlordosis with excessive pelvis anteversion. Global sagittal disbalance was observed in all patients.Conclusion. Apart from typical anatomical and roentgenological changes in pelvic and femoral componentsof the joint the children with dysplastic femur subluxation are characterized by excessive pelvic anteversion. Criteria of above parameters are identical and do not depend on the number of joints involved into the pathological process. Cranial dislocation of femoral head results to abnormalities of sagittal spine-pelvis ratios. Pathological process in hip joints and abnormality of spine-pelvis ratios results in negative changes of sagittal spine profile in the form of hyperlordosis, of physiological criteria of thoracic kyphosis and of the global sagittal disbalance. All of the above leads to overload of spinal motion segments and development of spine degenerative and dystrophic changes at early age.

Kinematic adaptation and changes in gait classification in running compared to walking in children with unilateral spastic cerebral palsy

BackgroundClassification of sagittal gait patterns in unilateral spastic cerebral palsy (CP) provides direct implication for treatment. Five types are described: type 0 has minor gait deviation; type 1 has inadequate ankle dorsiflexion in swing; type 2 has inadequate ankle dorsiflexion throughout the gait cycle; types 3 and 4 have abnormal function of the knee and hip joint respectively. During gait analysis of children with unilateral spastic CP we observed frequently that a knee flexion deficit disappeared during running. That may have an impact on classification and treatment. Research questionDoes the classification type change while running and how do patients’ kinematics adapt to running? Methods64 children with unilateral spastic CP were classified using instrumented gait analysis for walking and running. The deviation of four parameters from typically developing children (TD) were used to distinguish between types: peak ankle dorsiflexion in swing for type 1, peak ankle dorsiflexion in stance for type 2, knee range of motion for type 3, and hip range of motion for type 4. A three-factor ANOVA for factors group (CP/TD), locomotion (walk/run) and limb side (in-/uninvolved) was conducted. ResultsThe number of patients with type 1, 3 and 4 decreased considerably from walking to running, whereas, the number of type 0 and 2 patients increased. The ANOVA showed that three of four parameters of patients’ pathologic limb adapt similarly to TD to running, except for the ankle dorsiflexion in stance. SignificanceRunning shows that there is a natural way to resolve abnormalities. Therefore, recommended treatments of hip and knee joint abnormalities based on the walking classification can be questioned and additional running analysis may be important for surgical decision making.

Three dimensional gait analysis in patients with symptomatic component mal-rotation after total knee arthroplasty.

Purpose of the present cohort study was the determination of lower body function and rotation in patients with symptomatic component mal-rotation after total knee arthroplasty using instrumented 3D gait analysis. A consecutive series of 12 patients (61.3years ± 11.4years) were included suffering under remaining pain or limited range of motion at least six months after total knee arthroplasty. A CT-scan according to the protocol of Berger et al. and instrumented 3D gait analysis were carried out including clinical examination, videotaping, and kinematic analysis using a Plug-in Gait model. Outcome variables were temporospatial parameters as well as kinematics in sagittal and transversal plane. Data for reference group were collected retrospectively and matched by age and gender. Temporospatial parameters of the study group showed decreased velocity, cadence, and step length as well as increased step time. Single limb support was reduced for the affected limb. In sagittal plane, maximum knee flexion during swing phase was reduced for the replaced knee joint. In transverse plane, there was hardly any difference between affected and non-affected limb. Compared to the reference group, both limbs show significant increased internal ankle rotation and external hip rotation. There were significant strong linear correlations between ankle rotation and hip rotation as well as ankle rotation and radiological tibial mal-rotation. Patients with symptomatic component mal-rotation after total knee arthroplasty showed typically functional deficits. The affected and non-affected limb showed significant increased internal ankle rotation and external hip rotation, while only the affected, replaced knee showed reduced internal knee rotation. Identification of rotational abnormalities of hip and ankle joints seems to be mandatory in TKA to identify the patient group with external hip rotation, internal ankle rotation, and an elevated risk for symptomatic rotational TKA component mal-alignment.

Bone density changes following surgical correction of femoroacetabular impingement deformities

Femoroacetabular impingement (FAI) involves abnormal hip biomechanics due to deformities and is associated with osteoarthritis. Bone mineral density (BMD) in the acetabulum is higher in subjects with convex femoral (cam) FAI deformities compared to control subjects. The objective of this study was to assess post-operative changes of BMD with and without surgical correction of the cam deformity. Thirteen patients with bilateral cam deformities but unilateral symptoms underwent pre-operative and follow-up computed tomography (CT) scans of both hips. The deformity was surgically removed from the symptomatic hip. BMD was measured in regions of interest (ROI) around the superior acetabulum from CT scans at both time points. The contralateral untreated hip was used as a within-patient control. Changes in BMD were assessed by two-way repeated measures ANOVA (side, time) and paired t-tests. A greater BMD decrease was seen in the treated compared to the untreated hip (P<0.0018). BMD within the superior acetabulum decreased by 39mg/cc on the treated side (P<0.0001) but only 9mg/cc (P=0.15) in the untreated contralateral hip. These changes represent 7.1% and 1.7% of the pre-operative BMD on the respective sides. BMD decreased in the treated hip, suggesting a positive effect of surgical correction in relieving stresses within the hip joint. Longer term follow-up is required to assess the ultimate fate of the articular cartilage within the joint. This study showed that surgical correction of the cam deformity in patients with FAI may alter the pathological biomechanics within the joint.

The 'clicky hip': to refer or not to refer?

The significance of the 'clicky hip' in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with 'clicky hips' to our dedicated DDH clinic. A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with 'clicky hips' as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. There were 69 'clicky hip' referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as 'clicky hips' were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 'clicky hip' referrals required intervention with either harness or surgery. Our study provides further evidence that the 'clicky hip' referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for 'clicky hip' referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249-52.

Early prophylactic intervention: Avoiding or deferring arthroplasty?

Arthrosis of the hip joint can be a significant source of pain and dysfunction. While hip replacement surgery has emerged as the gold standard for the treatment of end stage coxarthrosis, there are several non-arthroplasty management options that can help patients with mild and moderate hip arthritis. The purpose of this paper is to review early prophylactic interventions that may help defer or avoid hip arthroplasty.Primary hip joint arthrosis is rare, and therefore treatments such as periacetabular osteotomies, surgical dislocation, and hip arthroscopy and related procedures are aimed to minimize symptoms but potentially also aim to alter the natural history of hip diseases. The state of the articular cartilage at the time of surgery is critical to the success or failure of any joint preservation procedures. Additionally, failure to appropriately address the underlying hip condition and properly correct the abnormal hip mechanics can lead to accelerated joint arthrosis.Consequently, proper evaluation, diagnosis, and appropriate surgical interventions when indicated can relieve pain and improve function in young patients with pre-arthritic hip conditions without arthroplasty. While these joint preservation procedures can frequently delay the need to THA, their impact on the natural course of the various disease processes remain unclear.

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

AbstractPain and debilitating symptoms due to hip osteoarthritis (OA) can significantly compromise quality of life in young, active patients. The management of the young adult with hip OA presents a unique set of challenges, with symptoms that originate from a variety of underlying hip pathologies, and patient age spanning from youth through middle age. Early options for hip OA include nonoperative treatment with anti-inflammatory medications, physical therapy, and injections. For patients with structural hip abnormalities (femoroacetabular impingement or dysplasia), arthroscopy or reconstructive osteotomy are acceptable treatment options. In advanced disease, joint-preserving techniques are often ineffective, and patients may require joint resurfacing or replacement. The treatment strategies for early hip OA continues to evolve with the development of new and refined surgical techniques, especially in the setting of underlying hip pathology, and a growing popularity of utilizing biologic agents. The purpose of this manuscript is to review current conservative and surgical management and to describe an algorithm for treatment of early-onset hip OA.

Natural History of Structural Hip Abnormalities and the Potential for Hip Preservation

Hip osteoarthritis (OA) exerts a significant burden on society, affecting 3% of Americans aged >30 years. Recent advances in the understanding of the pathoanatomy and pathomechanics of the hip have led to treatment options for young adults with hip pain. Femoroacetabular impingement, specifically cam-type femoroacetabular impingement, hip dysplasia, and the sequelae of pediatric hip disease can predispose the hip to early OA. However, many patients with abnormal anatomic findings do not develop early OA, suggesting that there exist other patient characteristics that are protective despite abnormal bony anatomy. Outcome studies show that arthroscopic and open hip procedures improve pain and function in patients with symptomatic hips. However, there is currently limited evidence that these procedures extend the life of the patient's natural hip. Additional studies are needed to determine protective or adaptive factors in patients with abnormal anatomy who do not develop early OA and to determine whether joint preserving hip surgery extends the life of the native hip joint.

Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference.

To validate SHOMRI gradings in preoperative hip magnetic resonance imaging (MRI) with intra-arthroscopic evaluation of intraarticular hip abnormalities. Preoperative non-arthrographic 3.0-T MRIs of 40 hips in 39 patients (1 patient with bilateral hip surgery) with femoroacetabular impingement (FAI) syndrome (mean age, 34.7 years ± 9.0; n = 16 females), refractory to conservative measures, that underwent hip arthroscopy were retrospectively assessed by two radiologists for chondrolabral abnormalities and compared with intra-arthroscopic findings as the standard of reference. Arthroscopically accessible regions were compared with the corresponding SHOMRI subregions and assessed for the presence and grade of cartilaginous pathologies in the acetabulum and femoral head. The acetabular labrum was assessed for the presence or absence of labral tears. For the statistical analysis sensitivity and specificity as well as intraclass correlation (ICC) for interobserver agreement were calculated. Regarding chondral abnormalities, 58.8% of the surgical cases showed chondral defects. SHOMRI scoring showed a sensitivity of 95.7% and specificity of 84.8% in detecting cartilage lesions. Moreover, all cases with full-thickness defects (n = 9) were identified correctly, and in n = 6 cases (out of n = 36 with partial-thickness defects) the defective cartilage was identified but the actual depth overestimated. Labral tears were present in all cases and the MR readers identified 92.5% correctly. ICC showed a good interobserver agreement with 86.3% (95% CI 80.0, 90.6%) CONCLUSION: Using arthroscopic correlation, SHOMRI grading of the hip proves to be a reliable and precise method to assess chondrolabral hip joint abnormalities. • Assessment of hip abnormalities using MRI with surgical correlation. • Comparing surgery and MRI by creating a hybrid anatomic map that covers both modalities. • Non-arthrographic use of 3.0-T MRI provides detailed information on cartilage and labral abnormalities in hip joints.

ISPR8-0437/The abnormalities of the hip and knee joints in patients with posterior tibialis tendon dysfunction: Comparison with healthy age-matched controls

Loss of the longitudinal arch and progressive hindfoot valgus are common clinical observations in the foot deformities of patients with posterior tibial tendon dysfunction (PTTD). The biomechanical abnormalities in patients with PTTD have been described, but few studies have investigated biomechanical chains of adjacent joints. Therefore, we examined the abnormalities of hip and knee joints through the gait analysis in subjects with PTTD. We compared 19 PTTD patients (average age: 67.1) with 30 age-matched control subjects (average age: 65.1). Subjects’ demographics was showed in Table 1 . Gait analysis was performed with a nine-camera motion-capture system and four force plates, using the VICON Plug-In-Gait and VICON Nexus software. Temporal-spatial parameters were compared between PTTD and control subjects, and joint angle and joint moment data were compared between the affected limb, the contralateral limb, and the right limb in control subjects. Subjects with PTTD had increased stance phase ratio and decreased stride length, cadence, and gait speed. The limbs of subjects with PTTD showed increased knee internal rotation at lording response, which was biased to abduction in the knee joint during the gait cycle, and irregular hip flexion and knee extension moment in the terminal stance, especially in the contralateral limb. We believe that the subjects with PTTD have an increased risk of knee osteoarthritis in both the affected and contralateral limbs.

Sensitivity of Magnetic Resonance Imaging in Evaluation of Patients with Hip Joint Pain

Abstract Introduction Modern magnetic resonance imaging (MRI) has a great sensitivity in detecting hip joint abnormalities, and because of its property of excellent visualization of soft tissue and nonionizing radiation, it is the modality of choice these days in not only adults but also pediatric musculoskeletal pathologies. Materials and Methods It was a prospective study performed in a tertiary care institute from 2016 to 2018. Total 64 cases with hip pathology attending orthopedics OPD (out patient department) and consenting to participate were included in the study. All the consenting participants were subjected to MRI scan. Results The most common pathology detected was avascular necrosis consisting of 28 cases. The next most common abnormality detected was infective arthritis, found in seven cases. Three patients were diagnosed with metastasis. Conclusion MRI is the diagnostic modality of choice for pathologies of hip for which radiographic and clinical findings are inconclusive. With MRI, one can stage the pathology to prognosticate and influence therapeutic decisions.

Which Clinical Exam findings are most predictive of an abnormal hip ultrasound in the newborn? A chart review from a Canadian pediatric hospital

Abstract BACKGROUND Developmental dysplasia of the hips is a condition that if not detected early and managed properly can lead to lifelong morbidity. The incidence of DDH in most developed countries is reported to be 1.5 to 20 cases per 1000 births. The Canadian Task Force on Preventive Health Care reports fair evidence to include a serial clinical examination of the hips by a trained clinician in the periodic health examination of all infants until they are walking independently. The indications for ultrasound examination are less clear. Guidelines for the clinical exam cite indications of imaging to be unstable hip, hip laxity, hip click and asymmetric skin folds. Given that some of these findings are extremely common it is likely that a large number of normal hips are being imaged unnecessarily. OBJECTIVES The purpose of this project is to determine which clinical findings are most predictive of an abnormal hip on ultrasound. It is hoped that this will assist the paediatrician or family doctor to balance unnecessary testing with the fear of missing an abnormal hip. DESIGN/METHODS All hip ultrasounds performed at a Canadian children’s hospital during 2016/17 on infants less than one year were reviewed for indication and outcome. The birth rate for the same year was 2,861. A total of 528 hip ultrasounds were performed. 156 ultrasounds were ordered by Paediatric Orthopaedic specialists and thus were not reviewed, leaving 372 ultrasounds for review. Ultrasounds were classified by age category at the time of imaging: &lt;14 days, 14–28 days, 29–60 days, 61 days-6 months, 6 months-1 year. Tests were ordered by paediatricians, neonatologists, family doctors and nurse practitioners. The indications for ultrasound were categorized into 9 categories; hip click, hip laxity, unstable hip (positive Barlow, dislocatable hip), asymmetric skin folds, breech presentation, family history of DDH, hip click + breech, hip laxity + breech, or no indication given. When multiple terms were noted on requisition a hierarchy was followed with hip laxity&gt;hip click&gt;asymmetric skin folds. Ultrasound reports reported as normal or abnormal. RESULTS The primary indication for hip ultrasound was asymmetric skin folds, (N-132); followed by Hip laxity (N-101), Hip click (N-72), Unstable hip (positive Barlow, dislocatable hip) (N-31), no indication noted (N-23), Breech presentation (N-8), Family History of DDH (N-3) and other (N-2). The ultrasound findings with asymmetric skin folds revealed 100% of tests were normal (132/132) on first ultrasound regardless of baby’s age at imaging. For Hip laxity, 93% (94/101) ultrasounds were normal following second ultrasound and for hip click, 99% (71/72) were normal following second ultrasound. For those ultrasounds that were performed for hip click and hip laxity (N-173), only one ultrasound would have been required if performed at greater than 8 weeks of age. In the unstable hip, 82% (28/34) were normal following second ultrasound. None of the ultrasounds performed for risk factors such as family history or breech presentation were abnormal but when combined with a lax hip exam 3 were reported as abnormal. In our study, a diagnosis of DDH was given to 15/2,861 newborns. Of these 15; the clinical finding was 7/16 hip laxity alone, 6/16 unstable hip, 3/16 hip laxity + breech. CONCLUSION Though practitioners must continue to be vigilent in clinical hip surveillance, symmetric skin folds and isolated hip click are low yield indications for hip ultrasound in the newborn. For hip laxity or unstable hip, waiting until 8 weeks improves the reliability of the ultrasound result and thus reducing unnecessary retesting. The breech presentation alone did not increase diagnosis but when combined with exam was predictive.

Hip Injury - Soccer

ACSM 2018 National Conference Clinical Case Abstract Submission Title: Hip Injury - Soccer Author: James Alex, Heather Gillespie, Maine Medical Center, Portland, ME. Email: [email protected] (Sponsor: Heather Gillespie, FACSM) HISTORY: A 13 year old male soccer player without significant past medical history sustained an acute onset of anterior right hip pain while sprinting during a soccer game. He was immediately unable to walk and was carried off the field by teammates. He developed occasional transient episodes of pain radiating down his right leg without numbness or tingling noted. He was evaluated in the emergency department that evening, given oxycodone for analgesia, crutches to maintain non-weight-bearing status, and was referred to sports medicine for follow-up. PHYSICAL EXAM: Examination in the office 2 days after injury revealed no hip, leg, or abdominal abnormalities on inspection. He was able to bear about 50% of his weight on the right leg without crutches. Mild tenderness to palpation was noted anterior to the right lesser trochanter. Right hip active range of motion was limited to 10 degrees of flexion in the supine position with normal passive range of motion throughout and intolerance of resisted hip flexion. Normal resisted adduction strength was noted. Neurovascular testing of the right lower extremity was normal. DIFFERENTIAL DIAGNOSIS: 1. Iliopsoas strain 2. Apophyseal avulsion fracture: AIIS, ASIS, or lesser trochanter. 3. Adductor strain 4. Femoral neck stress fracture 5. Slipped capital femoral epiphysis TESTS AND RESULTS: 2-view xray of the right hip reveals apophyseal avulsion fracture of the lesser trochanter of the right femur with 20mm of proximal displacement. FINAL DIAGNOSIS: Closed, proximally-displaced apophyseal avulsion fracture of the lesser trochanter of the right femur. TREATMENT AND OUTCOME: 1. Case reviewed with multiple surgeons (sports, trauma, pediatric orthopedics) regarding potential screw fixation. 2. Non-operative management pursued. 3. Stable proximal displacement visualized on repeat xray post-injury day 6. 4. Non-weight-bearing on crutches for 3 weeks. 5. OTC analgesia after post-injury day 3. 6. Gradual weight bearing by week 4. 7. Final return to sport pending at the time of submission.

Hip joint loading during walking in people with hip osteoarthritis: a systematic review and meta-analysis

Purpose: Hip osteoarthritis (OA) is a prevalent and costly chronic musculoskeletal condition that often results in pain and physical dysfunction. Evidence-based modifiable treatment targets for hip OA remain somewhat elusive and are largely based on evidence from the knee OA literature. Osteoarthritis is considered, at least in part, a mechanical disease. Preliminary evidence implicates abnormal hip joint loading in the pathogenesis of hip OA. Given that hip joint loading is potentially modifiable, there is a need to synthesise the evidence regarding hip joint loading during walking in individuals with hip OA to inform appropriate treatment targets. This systematic review and meta-analysis investigated hip joint loading during walking in people with hip osteoarthritis (OA). Methods: Five databases were searched up to March 29th, 2017. Studies that measured hip joint moments in the frontal or sagittal plane during walking in people with hip OA and contained either a healthy control group or the unaffected leg for comparison were included. Standardised mean differences (SMD) in measures of sagittal and frontal plane loading were pooled as appropriate, using a random effect approach. Univariate meta-regressions were further performed to explore if study and participant characteristics could explain heterogeneity. Among the variables evaluated as predictors of study heterogeneity were sample size, age, body mass index, sex, and walking speed. A further disease-stage sub-group analysis between studies with participants with end-stage hip OA, defined as awaiting hip replacement, and studies with participants with less severe hip OA (early, mild-to-moderate; not awaiting hip replacement) was performed. Methodological quality was assessed using the Downs and Black checklist. Results: Eleven studies with 1,036 participants were eligible and 10 studies were suitable for meta-analyses. Overall, people with hip OA had lower sagittal (SMD −0.83; 95%CI −0.99, −0.67) and frontal plane loading (SMD −0.70; 95%CI −1.12, −0.12) compared to controls. However, substantial heterogeneity was observed (I2 ≤ 90%). Meta-regression analysis determined no association between the SMD in peak external hip flexion moment with any of the study or participant characteristics investigated. In the frontal plane, the meta-regression analysis found an association between the SMD in peak external hip adduction moment and sample size (unstandardized ß −0.01; 95%CI −0.03, 0.00), such that the difference increased as sample size increased. Results by disease stage suggest that people with less severe hip OA have comparable sagittal (SMD 0.04; 95%CI −0.50, 0.58; I2 = 70%) and frontal (SMD 0.01; 95%CI −0.41, 0.43; I2 = 0%) plane loading compared to controls. People with end-stage hip OA have lower sagittal (SMD −1.04; 95%CI −1.45, −0.64; I2 = 74%) and frontal (SMD −0.67; 95%CI −1.12, −0.12; I2 = 71%) plane loading compared to controls. The methodological quality of the studies was generally moderate (and ranged from 53%–92%), with higher scores indicating better quality. Conclusions: Collective consideration of all studies and findings from the meta-analyses suggests that people with hip OA have lower sagittal and frontal plane hip joint loading compared with healthy controls. However, analysis on a limited number of studies indicates that differences in hip joint loading may be dependent on disease stage. People with end-stage hip OA exhibit lower hip joint loading compared to controls, while those with less severe disease appear to be comparable with controls. These findings may have relevance for management in early stages of the disease pathway.

Quantitative Assessment of Knee Progression Angle During Gait in Children With Cerebral Palsy.

Abnormal hip rotation is a common deviation in children with cerebral palsy (CP). Clinicians typically assess hip rotation during gait by observing the direction that the patella points relative to the path of walking, which is referred to as the knee progression angle (KPA). Two kinematic methods for calculating the KPA are compared with each other. Video-based qualitative assessment of KPA is compared with the quantitative methods to determine reliability and validity. The KPA was calculated by both direct and indirect methods for 32 typically developing (TD) children and a convenience cohort of 43 children with hemiplegic type CP. An additional convenience cohort of 26 children with hemiplegic type CP was selected for qualitative assessment of KPA, performed by 3 experienced clinicians, using 3 categories (internal, >10 degrees; neutral, -10 to 10 degrees; and external, >-10 degrees). Root mean square (RMS) analysis comparing the direct and indirect KPAs was 1.14+0.43 degrees for TD children, and 1.75+1.54 degrees for the affected side of children with CP. The difference in RMS among the 2 groups was statistically, but not clinically, significant (P=0.019). Intraclass correlation coefficient revealed excellent agreement between the direct and indirect methods of KPA for TD and CP children (0.996 and 0.992, respectively; P<0.001).For the qualitative assessment of KPA there was complete agreement among all examiners for 17 of 26 cases (65%). Direct KPA matched for 49 of 78 observations (63%) and indirect KPA matched for 52 of 78 observations (67%). The RMS analysis of direct and indirect methods for KPA was statistically but not clinically significant, which supports the use of either method based upon availability. Video-based qualitative assessment of KPA showed moderate reliability and validity. The differences between observed and calculated KPA indicate the need for caution when relying on visual assessments for clinical interpretation, and demonstrate the value of adding KPA calculation to standard kinematic analysis. Level II-diagnostic test.

The Prevalence of Cam and Pincer Morphology and Its Association With Development of Hip Osteoarthritis.

Synopsis Our understanding of femoroacetabular impingement syndrome is slowly improving. The number of studies on all aspects (etiology, prevalence, pathophysiology, natural history, treatment, and preventive measures) of femoroacetabular impingement syndrome has grown exponentially over the past few years. This commentary provides the latest updates on the prevalence of cam and pincer hip morphology and its relationship with development of hip osteoarthritis (OA). Cam and pincer morphology is highly prevalent in the general population and in this paper is presented for different subgroups based on age, sex, ethnicity, and athletic activity. Methodological issues in determining prevalence of abnormal hip morphology are also discussed. Cam morphology has been associated with development of hip OA, but the association between pincer morphology and hip OA is much less clear. Results from reviewed studies, as well as remaining gaps in literature on this topic, are critically discussed and put into perspective for the clinician. J Orthop Sports Phys Ther 2018;48(4):230-238. doi:10.2519/jospt.2018.7816.

Prediction of risk of development of type 2 diabetes mellitus using Indian diabetic risk score in rural areas of Hassan

Background: It has been estimated by International Diabetic Federation (IDF) that globally as many as 193million people with diabetes, are unaware of their disease, the use of a simple easy to use, non-invasive and cost effective screening tool for community based screening is the need of the hour. This study was taken with objective to assess the risk of development of type 2 diabetes mellitus using Indian diabetic risk score (IDRS), and to determine the association of IDRS with socio-demographic factors.Methods: Cross sectional study was conducted for 3 months in rural areas of Hassan. 480 subjects were chosen by systematic random sampling considering inclusion and exclusion criterions. Data was collected from individuals who were more than 30 years old and not having diabetes. IDRS components were assessed along with other socio demographic components.Results: Out of 480 participants, 256 (53.4%) were females, mean age of the participants 42.38±18.6. 47% belong to class III socioeconomic status, 63%of them are educated, 49% of participants having BMI ≥25, 41% (&gt;0.8) female and 33% (&gt;0.9) male having abnormal waist hip ratio (WHR), 49% of the participants having IDRS score &gt;50 among these high risk participants 35% were having RBS &gt;200. All 24 (100%) morbid obese individuals were having high IDRS score; among these 66.6% have abnormal RBS. IDRS predicted the risk of DM with sensitivity 81% and specificity 59%.Conclusions: As the study finds that percentage random blood glucose is more among participants of high IDRS, thus a simple IDRS tool can be used in the field for mass screening and early intervention.

Sports Physical Therapy Section Poster Presentations (Abstracts SPO1-SPO166).

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, SPO designates a Sports Physical Therapy Section poster presentation. J Orthop Sports Phys Ther 2018;48(1):A203-A276. doi:10.2519/jospt.2018.48.1.A203.