Cause Of Hip Pain Research Articles

State of the Art in Rehabilitation Strategies After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review

Background/Objectives: Femoroacetabular impingement (FAI) is a common cause of hip pain in athletes and active individuals, often requiring hip arthroscopy followed by a structured rehabilitation program. Effective rehabilitation is crucial for optimizing surgical outcomes and facilitating a return to sport. Methods: A systematic review following PRISMA guidelines was conducted to evaluate post-operative rehabilitation protocols after hip arthroscopy for FAI. Databases searched included PubMed, Embase, and Cochrane Library up to April 2024. Inclusion criteria focused on studies documenting rehabilitation post-arthroscopy for FAI, with a final selection of 14 studies encompassing 1105 patients. Data extraction focused on rehabilitation techniques, functional outcomes, and return-to-sport rates. The risk of bias was assessed using RoB2 and ROBINS-I tools. Results: Rehabilitation protocols were categorized into four phases, emphasizing manual therapy, strengthening, stretching, aquatic exercises, and sport-specific drills. The average return-to-sport rate was 90.3%. Manual therapy and aquatic programs were critical in early recovery, while strengthening and proprioception exercises were central to later stages. Variability in protocols across studies was noted. Conclusions: Post-operative rehabilitation following hip arthroscopy for FAI is essential for recovery. A phased, individualized approach, integrating manual therapy, aquatic exercises, and sport-specific training, yields positive outcomes. However, the heterogeneity of protocols suggests the need for standardized guidelines tailored to individual patient needs and activity levels.

Clinical Efficacy of Ultrasound-guided Iliopsoas Corticosteroid Injection for Hip Pain

Introduction. Iliopsoas bursitis and tendinopathy are common causes of hip pain and major contributors to snapping hip syndrome, which affects 5-10% of the general population. These conditions are often treated with conservative measures, including corticosteroid injections into the iliopsoas bursa. However, the clinical effectiveness of such injections has not been well studied. Through this study, the authors evaluated the efficacy of ultrasound-guided corticosteroid injections into the iliopsoas bursa. Methods. The study involved 68 patients diagnosed with iliopsoas tendinopathy, iliopsoas bursitis, or snapping hip syndrome (coxa saltans). The authors used a single-sample, nonexperimental design. Participants completed measures assessing pain, mechanical symptoms, physical function, activity level, and total hip score at baseline, 3-month, and 6-month post-injection. Data were collected from January 1, 2023, to April 1, 2024. Repeated measures ANOVA was used to assess changes in outcome measures. Results. Participants showed significant improvements in pain, mechanical symptoms, physical function, and activity level at both 3-month and 6-month follow-ups. Additionally, overall hip scores improved statistically by the end of the study. Conclusions. Our data suggest that ultrasound-guided iliopsoas bursa corticosteroid injections can be effective in improving physical function and ability to perform daily activities and engage in physical tasks and reduce the disability associated with iliopsoas tendinopathy. Further research with a longer follow-up period and more rigorous controls is warranted to confirm these findings and assess the long-term benefits and potential risks of the procedure.

The prevalence of synovitis during hip arthroscopy for labral tears – An observational study

Objectives: Hip pain, secondary to labral tears (LT), can significantly impact the quality of life in the young adult population. LTs can be an incidental finding or can arise from underlying pathology, most commonly from femoroacetabular impingement (FAI). The cause of hip pain in young adults can represent a diagnostic challenge to clinicians. Magnetic resonance imaging (MRI)/magnetic resonance arthrography may be inconclusive in some cases. Therefore, diagnostic hip arthroscopy may be performed to provide a definitive diagnosis and to address intra-articular pathology. During hip arthroscopy, synovitis is often an initial finding. Synovitis can have multiple causes or can also be idiopathic. The aim of this study was to determine the incidence of synovitis detected during hip arthroscopy in patients with an MRI-confirmed LT. Materials and Methods: We conducted a prospective review of 50 consecutive patients undergoing hip arthroscopy who had a confirmed LT on MRI. We recorded the presence or absence of synovitis during the initial insertion of the arthroscope. In addition, we recorded demographic data and the grade of LT identified. Results: During hip arthroscopy, 31 patients had synovitis present, while 19 did not have synovitis. No significant difference was identified when comparing Visual Analog Score and EQ5D scores between both cohorts. Conclusion: Our study found that synovitis is a common finding during hip arthroscopy for FAI syndrome, with 62% of patients with an MRI diagnosis of LT associated with FAI having global hip synovitis present at the time of surgery.

Poster 214: Cross Sectional Area of Hip Muscles Before and After Surgery for Femoroacetabular Impingement

Objectives: Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain and surgery is a treatment option for patients who do not respond to conservative treatment. Previous studies have identified increases in postoperative hip muscle volume and cross-sectional area (CSA) as associated with increases in patient reported outcomes following hip surgery. There has been a lack of literature analyzing the change of hip muscle cross sectional CSA on MRI following arthroscopic hip surgery for FAI and the effect of changes in hip muscle CSA on patient reported outcomes following surgery. The purpose of this study is to analyze the change in hip muscle cross sectional area (CSA) after arthroscopic surgery for FAI syndrome. Methods: This is a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023. All patients who had a pre-operative MRI within 1 year of their date of surgery and at least one postoperative MRI were included in the study. Cross sectional areas were measured by one blinded researcher and results were checked for reliability by a musculoskeletal radiologist. Statistical analysis was completed using SPSS, Version 24 and normally distributed continuous variables between cohorts were compared using the two-sample Student t test. Results: Initially 1390 patients were included in the study but only 95 were found to have a preoperative hip MRI within 1 year of their date of surgery as well as a postoperative MRI. The average age of the cohort was 35.8 ± 15.7, the cohort was 33.7% male and 66.3% female, and had an average BMI of 23.3 ± 8.1. The mean time between surgery and postoperative MRI was 14.8 ± 8.3 months. There was a significant difference between preoperative and postoperative hip muscle CSA for gluteus maximus (4298.6±883.6 mm2 vs. 4384.6±967.6 mm2, p<0.01), gluteus minimus (1037.0±199.2 mm2 vs. 1074.9±202.3 mm2, p<0.001), and pectineus (415.7±121.9 mm2 vs. 426.7±106.3 mm2, p=0.04). There were no other significant differences between preoperative and postoperative hip muscle CSA values between the other muscles analyzed. A linear regression found that an increase in the change in CSA of the gluteus maximus significantly predicted an increase in mHHS at 1 year (β=3.103, p=0.046) when controlling for age, sex, BMI and time from surgery to postoperative MRI. A linear regression found that an increase in the change in cross sectional area of the pectineus significantly predicted an increase in NAHS at 1 year when controlling for age, sex, BMI and time from surgery to post-op MRI (β=0.186, p=0.037). Conclusions: Patients who undergo surgery for FAI have significantly increased gluteus maximus, gluteus minimus and pectineus muscle CSA on post-operative MRIs. Furthermore, increases in both gluteus maximus and pectineus muscle CSA was found to be significantly associated with increases in mHHS and NAHS at 1 year follow up respectively.

Bilateral transient osteoporosis of the hip: a neglected cause of hip pain during pregnancy

Bilateral transient osteoporosis of the hip: a neglected cause of hip pain during pregnancy

SHORT-TERM COMPLICATIONS AND REOPERATION RATES AFTER PELVIC OSTEOTOMY: A REVIEW OF 1,348 CASES IN ENGLAND FROM 2010 TO 2023

Hip dysplasia is a common cause of hip pain in young adults. Pelvic osteotomy (PO) techniques are the gold standard for treating symptomatic patients, albeit technically demanding. This study aimed to (1) evaluate the 90-day complication rate, and (2) investigate the reasons, frequency and timing of reoperations following primary PO procedures.We retrospectively analysed the National Hospital Episode Statistics database, examining all patients aged over 14 who underwent PO in NHS England hospitals from 2010 to 2023. We identified index procedures and reoperations using relevant OPCS-4 codes. We analysed patient demographics, 90-day complications, and readmission rates for ipsilateral metalwork removal, revision PO, hip arthroscopy (HA), and THR conversion, and calculated the mean time to reoperations.This study included 1,348 PO cases (mean age: 28.7±9.1 years, 89.5% female). The mean hospital stay was 5.4±3.9 days, with a 90-day readmission rate of 0.52% at a mean of 51.0±17.2 days. The most common causes were infection (0.22%) and reoperation (0.15%). The 90-day rate of pulmonary embolism and deep vein thrombosis was 0.074%. One patient died within 90 days.Overall, 810 patients (60.1%) were readmitted for a subsequent hip procedure at a mean of 2.12±1.90 years following their primary PO. Metalwork removal was required in 616 patients (45.7%) at a mean of 1.70±1.19 years. Readmission rates for revision PO, HA, and THR, were 4.23% (mean time: 2.89±0.82 years), 4.15% (mean time: 2.91±2.28 years) and 6.01% (mean time: 5.24±3.08 years) respectively.This study highlights a low 90-day complication rate following primary PO, but a high reoperation rate, mainly for metalwork removal. We provide the most up-to-date report of revision PO, HA and THR conversion rates in England. These findings provide valuable insight that can facilitate informed decision-making, expectation-setting, and post-operative planning, also establishing a benchmark for future quality improvement.

Neuropathic pain is a feature in patients with symptomatic femoral acetabular impingement

Femoral acetabular impingement syndrome (FAIS) is a cause of hip pain thought to be nociceptive, although pain phenotypes e.g., burning, pain attacks, prickling, numbness etc., are reported, mimicking neuropathic pain. Although no lesion to the somatosensory system is identified, neuropathic pain (NeP) may explain why nociceptive-focussed treatments are not always successful. ObjectiveTo identify NeP in patients with FAIS and investigate if related to poorer outcomes. DesignA secondary analysis of the Femoral Acetabular Impingement Trial (FAIT). Outcome of interest: PainDETECT questionnaire; secondary outcomes of interest; International Hip Outcome Tool (iHOT33), Hospital Anxiety and Depression Scale (HADS) and VAS ‘average pain over a month’, at baseline and 8 months follow-up. Intervention (surgery or physiotherapy) were pooled. Results173 data sets at baseline; 123 at 8 months follow-up. Baseline painDETECT identified three groups: 69% nociceptive, 19% unclear and 12% neuropathic pain phenotypes. Baseline, median scores were higher for the neuropathic group compared to the nociceptive group demonstrating borderline anxiety (9.5(5.3 to 14.2), 5(3 to 8), higher normal values for depression (7.5(2.3 to 11.8), (4(2 to 9), higher average pain (7 (6 to 8), 5(4 to 6) and lower iHOT33 14.2(9 to 21.1), 38.4(26.2 to 55.7). Post treatment, there was a median change in the neuropathic score in both iHOT33 (40.8 (25 to 76.5) with a median difference of 24.13 (CI 95% 10.46 to 45.92) and average pain 4.5(1.5 to 7) with a median difference of 2 (CI 95% 1 to 5) but to a lesser amount than the nociceptive group, iHOT33 (64(38.2 to 86.6) with a median difference of 15.50 (CI 95% 6.41 to 21.82) and average pain 3(1 to 5.7) with a median difference of 1 (CI 95% 0.5 to 1). ConclusionNeP exists in symptomatic FAIS patients and is associated with increased average pain, and functional limitations. Nociceptive-targeted treatment improves hip function and pain but with less improvement in the NeP group when compared to the nociceptive group.Pain phenotyping before intervention may improve outcomes. Contribution of paper•Neuropathic pain is a feature in patients with Femoral Acetabular Impingement Syndrome (FAIS).•Neuropathic pain is related to borderline levels of anxiety, higher average pain and poorer hip function.•Nociceptive focused treatment improves hip function and average pain in patients with neuropathic pain but to a lesser extent than patients with nociceptive pain.

Idiopathic aseptic necrosis of the femoral head in children who are professionally engaged in gymnastics: A literature review

BACKGROUND: Aseptic necrosis of the femoral head in school-age children is a severe, rapidly progressive degenerative and dystrophic disease. A significant proportion of girls aged 10 years with osteonecrosis of the femoral head have been professionally engaged in rhythmic gymnastics. The relationship between professional sports, in particular rhythmic gymnastics, and the development of this pathology and the mechanism of impaired blood flow in the femoral head in such cases remains unclear. The severity of the course and serious consequences of this disease in the form of multidimensional deformities of the femoral head, early arthrosis of the hip joint, and persistent disability, require close attention.
 AIM: To analyze modern world literature data on the etiology, pathomechanics, and features of the course and treatment of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics.
 MATERIALS AND METHODS: A literature search on the problem of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics in the open information databases was conducted in PubMed, Science Direct, and Library with an analysis depth of 20 years.
 RESULTS: The analysis of publications on the osteonecrosis of the femoral head allowed us to talk about the etiological connection of this condition with professional rhythmic gymnastics, namely, high-intensity repetitive loads on the hip joint of a child. Studies using in vivo laser Doppler flowmetry and 3D computer modeling prove the occlusion of blood vessel branches encircling the femur under excessive mechanical stress on the femoral head and potentially unfavorable positions in the hip joint – overextension (hyperextension), external rotation, and abduction.
 CONCLUSIONS: Professional gymnastics can be a risk factor for the development of osteonecrosis of the femoral head. Frequent late disease diagnoses with the development of severe deformity of the femoral head and end-stage coxarthrosis requiring total hip replacement in adolescents determine the need for early identification of the causes of hip pain in children engaged in gymnastics. The findings will help improve treatment results and reduce the number of organ replacement interventions.

Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain

PurposeTo evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration.Material and methodsDatabase was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8–17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain.ResultsSeventy patients (68% female; median age: 14.5 years; range:10.8–16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%).ConclusionMRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI.

Repair of Full-Thickness Gluteus Maximus Tear With Suture Anchors

Gluteal tendon tears are a common cause of hip pain. Most commonly, tears occur in the gluteus medius and minimus, and there are well-established nonoperative or operative treatment pathways. In this Technical Note, we describe our technique for repair of a full-thickness gluteus maximus tendon tear using anchor fixation.

Return-to-Sport Rates After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Flexibility Sports Athletes: A Systematic Review.

Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain in young adults. Flexibility athletes represent an interesting subset due to the extreme range of motion requirements of their sport. The objective of this review was to provide a summary of the outcomes of hip arthroscopy for FAIS in patients who participate in flexibility sports. Three online databases (Medline, Embase, and PubMed) were searched from database inception (1946, 1974, and 1966, respectively) to January 10, 2023. Studies were screened for literature addressing surgical outcomes for flexibility athletes undergoing hip arthroscopy for FAIS. Systematic review. Level 4. Various patient-reported outcomes that evaluated the efficacy of hip arthroscopy in this patient population were abstracted and presented in descriptive and analytical format. Abstraction was performed by 2 reviewers. Overall, a total of 8 Level 3 or 4 studies and 295 patients (312 hips) were included in this review. The pooled standardized mean differences for the Visual Analog Scale for pain score, Modified Harris Hip Score, Hip Outcome Score - Activity of Daily Living scale, and Hip Outcome Score - Sport-Specific Subscale all demonstrated significant improvement after undergoing arthroscopy for FAIS between 12 and 116 months (N = 175, -1.97, 95% CI -2.5 to -1.4, P < 0.01, I2 = 76%; N = 211, 1.82, 95% CI 1.49 to 2.16, P < 0.01, I2 = 52%; N = 164, 1.75, 95% CI 1.42 to 2.05, P < 0.01, I2 = 28%; N = 211, 1.71, 95% CI 1.38 to 2.04, P < 0.01, I2 = 52%, respectively). Across 289 patients, 75.6% to 98% returned to sport at a similar or higher level than presurgery. This review demonstrates a trend of improvement in patient-reported pain, function, quality of life, and return to sport at a minimum of 12 months among flexibility athletes after hip arthroscopy to treat FAIS.

Insight into Steroid-Induced ONFH: The Molecular Mechanism and Function of Epigenetic Modification in Mesenchymal Stem Cells.

Osteonecrosis of the femoral head (ONFH) is a common refractory orthopedic disease, which is one of the common causes of hip pain and dysfunction. ONFH has a very high disability rate, which is associated with a heavy burden to patients, families, and society. The pathogenesis of ONFH is not completely clear. At present, it is believed that it mainly includes coagulation dysfunction, abnormal lipid metabolism, an imbalance of osteogenic/adipogenic differentiation, and poor vascularization repair. The prevention and treatment of ONFH has always been a great challenge for clinical orthopedic surgeons. However, recent studies have emphasized that the use of mesenchymal stem cells (MSCs) to treat steroid-induced ONFH (SONFH) is a promising therapy. This review focuses on the role and molecular mechanism of epigenetic regulation in the progress of MSCs in the treatment of SONFH, and discusses the significance of the latest research in the treatment of SONFH from the perspective of epigenetics.

Factors Influencing The Manifestations of Coxarthrosis

Coxarthrosis, or hip osteoarthritis (OA), is one of the main causes of hip pain, which can affect patients of all ages, being one of the most common reasons for patients presenting to the specialized outpatient clinic. The objective of our research was to determine the number of patients with coxarthrosis who presented to the Department of Orthopaedics and Traumatology within the Emergency County Hospital of Drobeta Turnu Severin, between 2017-2019, the sex, age, social environment of the patients. All patients underwent a thorough clinical examination to determine the risk factors, the favouring factors and their correlation with the paraclinical data obtained through imaging investigation (pelvis X-ray, computer tomography and nuclear magnetic resonance). The study included 462 patients, aged between 23 and 89 years old, who were diagnosed with varying degrees of coxarthrosis within the specialized outpatient clinic. The main risk factors were obesity, osteoporosis, chronic smoking, rural environment, female sex, the existence of a hip injury and intense physical exertion. The main purpose of the research was to analyse a series of data, which would bring information on the incidence, distribution by age groups, sex, living environment and professional activity of the population with coxarthrosis, in order to develop a therapeutic management as effective as possible. Arthrosis is generally characterized by the loss of an important part of the joint cartilage, which causes local pain and reduced mobility.

Non-Operative Rehabilitation Principles for Use in Individuals with Acetabular Dysplasia: A North American Based Delphi Study.

Acetabular dysplasia (AD) is defined as a structurally deficient acetabulum and is a well-recognized cause of hip pain in young adults. While treatment of severe AD with a periacetabular osteotomy has demonstrated good long-term outcomes, a trial of non-operative management is often recommended in this population. This may be especially true in patients with milder deformities. Currently, there is a paucity of research pertaining to non-operative management of individuals with AD. To present expert-driven non-operative rehabilitation guidelines for use in individuals with AD. Delphi study. A panel of 15 physiotherapists from North America who were identified as experts in non-operative rehabilitation of individuals with AD by a high-volume hip preservation surgeon participated in this Delphi study. Panelists were presented with 16 questions regarding evaluation and treatment principles of individuals with AD. A three-step Delphi method was utilized to establish consensus on non-operative rehabilitation principles for individuals presenting with AD. Total (100%) participation was achieved for all three survey rounds. Consensus, defined a piori as > 75%, was reached for 16/16 questions regarding evaluation principles, activity modifications, appropriate therapeutic exercise progression, return to activity/sport criteria, and indications for physician referral. This North American based Delphi study presents expert-based consensus on non-operative rehabilitation principles for use in individuals with AD. Establishing guidelines for non-operative management in this population will help reduce practice variation and is the first step in stratifying individuals who would benefit from non-operative management. Future research should focus on patient-reported outcomes and rate of subsequent surgical intervention to determine the success of the guidelines reported in this study. Level V.

Knowledge mapping of programmed cell death in osteonecrosis of femoral head: a bibliometric analysis (2000–2022)

BackgroundOsteonecrosis of the femoral head (ONFH) is a common, refractory and disabling disease of orthopedic department, which is one of the common causes of hip pain and dysfunction. Recent studies have shown that much progress has been made in the research of programmed cell death (PCD) in ONFH. However, there is no bibliometric analysis in this research field. This study aims to provide a comprehensive overview of the knowledge structure and research hot spots of PCD in ONFH through bibliometrics.MethodThe literature search related to ONFH and PCD was conducted on the Web of Science Core Collection (WoSCC) database from 2002 to 2021. The VOSviewers, “bibliometrix” R package and CiteSpace were used to conduct this bibliometric analysis.ResultsIn total, 346 articles from 27 countries led by China and USA and Japan were included. The number of publications related to PCD in ONFH is increasing year by year. Shanghai Jiao Tong University, Xi An Jiao Tong University, Wuhan University and Huazhong University of Science and Technology are the main research institutions. Molecular Medicine Reports is the most popular journal in the field of PCD in ONFH, and Clinical Orthopaedics and Related Research is the most cocited journal. These publications come from 1882 authors among which Peng Hao, Sun Wei, Zhang Chang-Qing, Zhang Jian and Wang Kun-zheng had published the most papers and Ronald S Weinstein was cocited most often. Apoptosis, osteonecrosis, osteonecrosis of the femoral head, glucocorticoid and femoral head appeared are the main topics the field of PCD in ONFH. Autophagy was most likely to be the current research hot spot for PCD in ONFH.ConclusionThis is the first bibliometric study that comprehensively summarizes the research trends and developments of PCD in ONFH. This information identified recent research frontiers and hot directions, which will provide a reference for scholars studying PCD in ONFH.

High-resolution ultrasound in the evaluation of the adult hip.

This paper reviews ultrasound of the hip, which is a commonly requested examination for symptomatic hip issues. This includes both intra-articular and extra-articular causes of hip pain. Ultrasound is easily accessible, lacks radiation exposure, and allows for evaluation of the contralateral hip as well as assessment of dynamic maneuvers. Ultrasound can be used to guide interventional procedures. Ultrasound of the hip can be challenging due to the deep location of structures and complex anatomy. Typically, high-frequency transducers are used to examine the hip, however the choice of ultrasound transducer depends on the patient's body habitus, with lower frequency transducers required to penetrate deep structures in obese patients. It is important to have an approach to ultrasound of the hip which includes assessment of the anterior, lateral, posterior, and medial aspects of the hip. The technique and relevant anatomy of each of these compartments are discussed as well as the use of Doppler examination of the hip. Several dynamic maneuvers can be performed to help determine the cause of hip pathology in various locations, and these are described and illustrated. Ultrasound is useful for guided procedures about the hip, and these indications will be reviewed.

Case Report: Idiopathic avascular necrosis of the femoral head following pregnancy

Background: Hip pain during pregnancy is very common, but avascular necrosis (AVN) represents a very rare entity. Osteonecrosis of the head of the femur during the pregnancy, or shortly after the pregnancy, is a rare clinical problem. Little is known about pregnancy as an etiological factor for AVN of the femoral head. Case: In this case report, a documented case of femoral head osteonecrosis, a rare complication after pregnancy is presented. The patient presented with complaints of pain in the left hip that gradually worsened and led to restriction of movement. The patient was advised an X-ray, which showed a fracture of neck of the left femur, and an MRI following the X-ray revealed features of AVN of the hip. The patient was later taken for total hip arthroplasty, which was uneventful. On follow-up, the patient had relief from her symptoms and had no complications. Alcoholism, steroid use, systemic lupus erythematosus, organ transplantation (particularly following kidney or bone marrow transplantation), dyslipidemia (particularly hypertriglyceridemia), Gaucher disease, decompression sickness, and drepanocytosis are known risk factors for osteonecrosis. We can list pro-coagulation abnormalities, chemotherapy, and HIV among the less established factors. Here, we present a case of a patient with postpartum AVN of the femoral head that suffered AVN of the left hip in the post-partum period, her symptom of hip pain was neglected as a benign cause initially, which led to aggressive treatment (total hip arthroplasty) at a young age. Conclusions: Having high suspicion of the diagnosis of AVN and a low threshold for magnetic resonance imaging (MRI) imaging in a pregnant woman with hip pain is a requirement to avoid complications. This case highlights the need for high suspicion of osteonecrosis as a cause of hip pain in the post-partum period.

Team Approach: Hip Preservation Surgery.

The evaluation and treatment of adolescents and young adults with hip pain has seen tremendous growth over the past 20 years. Labral tears are well established as a common cause of hip pain but often occur because of underlying bony abnormalities. Femoroacetabular impingement (FAI) and acetabular dysplasia are now well-established causes of hip osteoarthritis and are increasingly treated in the prearthritic stage in hopes of improving symptoms and prolonging the longevity of the native hip. Beyond FAI and acetabular dysplasia, this patient population can present with a complex and variable group of underlying conditions that need to be taken into account. Expertise in the conservative management of this population, including physical therapy, is valuable to maximize the success. Preoperative, surgical, and postoperative decision-making and care in this population is complex and evolving. A comprehensive, multidisciplinary approach to the care of this patient population has been used for over 20 years by our institution with great success. The purpose of this article is to review the "team-based approach" necessary for successful management of the spectrum of adolescent and young adult hip disorders.

Better sex after hip arthroscopy; Sexual dysfunction in patients with femoro-acetabular impingement syndrome

BackgroundFemoro-acetabular impingement syndrome (FAIS) is a common cause of hip pain and functional decline. The quality of life of affected patients has been shown to be significantly diminished, with potential alterations in the ability to perform activities of daily living and recreation, including sexual function. Hip arthroscopy is the surgical technique recognized as the gold standard in FAIS. The aim of this study was to research the relationship between hip arthroscopy due to FAIS and pre- and postoperative sexual function. HypothesisThe hypothesis of the study was that sexual dysfunction would be common during the preoperative period but would significantly improve after surgery. Materials and methodsThis retrospective study included 96 patients aged 18 to 55 years, who underwent hip arthroscopy for a FAIS diagnosis between 2015 and 2021, with a minimum follow-up of one year. Exclusion criteria were a bilateral symptomatic hip condition, history of ipsilateral hip or knee surgery, history of urological or gynecological conditions, sexual dysfunction, or a history of hip osteonecrosis or osteoarthritis. The Female Sexual Function Scale (FSFI) was used to evaluate sexual dysfunction in females and the International Erectile Function Index (IIEF-5) for males. ResultsThe patients comprised 56.3% males and 43.82% females with a mean age of 35.3±8.3 years. Sexual dysfunction was determined preoperatively in 85.2% of the males and in 57.1% of the females. Overall improvement after surgery was statistically significant. Signs of pudendal nerve damage were seen during the postoperative period in 29 (30.2%) patients. The change in total sexual scores was significantly correlated with nerve symptoms and regression analysis showed that traction time was a significant risk factor for pudendal nerve symptoms. DiscussionSexual dysfunction is a common trait of patients suffering from FAIS and the majority of patients significantly benefit from the procedure. Sexual dysfunction persists in a category of patients during the postoperative period, regardless of the type of lesion, and this phenomenon is associated with transient pudendal nerve symptoms, which are more likely to occur with longer traction times and thus represent a clear risk factor. Level of evidenceIV.

Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. Purpose: To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. Results: A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort (P < .01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients (P = .19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P < .01; per year of increased age: HR, 1.1; P < .01; presence of cam: HR, 3.5; P < .01; per Tönnis grade: HR, 4.0; P < .01). Conclusion: At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up.