Cause Of Hip Research Articles

Hip and groin pain in sport

Hip and groin pain is a common symptom in the athletic population. Kicking sports are the most affected, with groin injuries accounting for almost one fifth of all injuries in male club football. Despite the frequency at which these injuries occur, diagnosing the cause of hip and groin pain can be a challenge. Correct diagnosis and management of hip and groin injuries in primary care can improve outcomes in patients by reducing the likelihood of re-injury and avoiding the development of chronic issues. This article aims to discuss the common causes of hip and groin pain in sports, and how to assess, investigate and manage these injuries.

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.

P01 An unusual case of pregnancy associated osteoporosis presenting with bilateral neck of femur fractures

P01 An unusual case of pregnancy associated osteoporosis presenting with bilateral neck of femur fractures

Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review.

BACKGROUND Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.AIMTo evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.METHODSA literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.RESULTSSeventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.CONCLUSIONAt least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.

Evaluation of efficacy and safety of traditional Chinese medicine in the treatment of hip synovitis in children: A protocol for systematic review and meta-analysis.

Background:Hip synovitis is a common hip disorder in children and a frequent cause of hip or groin pain in children. Its onset is rapid and poses a threat to patient health. Conventional treatment methods have suboptimal efficacy and large side effects. Clinical study surface, the therapeutic effect of traditional Chinese medicine (TCM) on hip synovitis in children is obvious. Therefore, we aimed to systematically review the efficacy and safety of TCM on hip synovitis in children.Methods:We will search databases including PubMed, Web of Science, EMBASE database, Cochrane Library, MEDLINE, Wanfang Data, Chinese biomedical literature database, China National Knowledge Infrastructure, Chinese science and technology journals database, and World Health Organization International Clinical Trials Registry Platform (since the databases were established). We also searched secondary resources, including the reference lists of studies. Included articles were carefully screened and reviewed by 2 researchers. Statistical analysis was performed using Review Manager 5.3 software.Results:This study will comprehensively evaluate the efficacy and safety of TCM for the treatment of hip synovitis in children.Conclusion:This systematic review explores the efficacy and safety of TCM for the treatment of hip synovitis in children and provides an update on its clinical use.

Cobalt ions induce metabolic stress in synovial fibroblasts and secretion of cytokines/chemokines that may be diagnostic markers for adverse local tissue reactions to hip implants

Adverse local tissue reactions (ALTRs) are a prominent cause of hip implant failure. ALTRs are characterized by aseptic necrosis and leukocyte infiltration of synovial tissue. The prevalence of ALTRs in hips with failing metal implants, with highest rates occurring in patients with metal-on-metal articulations, suggests a role for CoCrMo corrosion in ALTR formation. Although hypersensitivity reactions are the most accepted etiology, the precise cellular mechanism driving ALTR pathogenesis remains enigmatic. Here we show that cobalt ions released by failing hip implants induce mitochondrial stress and cytokine secretion by synovial fibroblasts: the presumptive initiators of ALTR pathogenesis. We found that in-vitro treatment of synovial fibroblasts with cobalt, but not chromium, generated gene expression changes indicative of hypoxia and mitophagy responses also observed in ALTRs biopsies. Inflammatory factors secreted by cobalt-exposed synovial fibroblasts were among those most concentrated in ALTR synovial fluid. Furthermore, both conditioned media from cobalt-exposed synovial fibroblasts, and synovial fluid from ALTRs patients, elicit endothelial activation and monocyte migration. Finally, we identify the IL16/CTACK ratio in synovial fluid as a possible diagnostic marker of ALTRs. Our results provide evidence suggesting that metal ions induce cell stress in synovial fibroblasts that promote an inflammatory response consistent with initiating ALTR formation. Statement of significanceWe demonstrate that the cytotoxic effects of cobalt ions on the synovial cells (fibroblast) is sufficient to trigger inflammation on hip joints with metal implants. Cobalt ions affect mitochondrial function, leading to the auto phagocytosis of mitochondria and trigger a hypoxic response. The cell's hypoxic response includes secretion of cytokines that are capable of trigger inflammation by activating blood vessels and enhancing leukocyte migration. Among the secreted cytokines is IL-16, which is highly concentrated in the synovial fluid of the patients with adverse local tissue reactions and could be use as diagnostic marker. In conclusion we define the cells of the hip joint as key players in triggering the adverse reactions to hip implants and providing biomarkers for early diagnosis of adverse reactions to hip implants.

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work...

Understanding Painful Hip in Young Adults: A Review Article.

A wide number of disorders, including pathologies outside the hip, can cause and refer pain to hip. However, determining the cause of a painful hip can be a major challenge to orthopedic surgeons. Failure to diagnose and appropriately investigate pathologies of the hip in adults may result in delayed management and prolonged patient morbidity. A systematic approach to investigating the etiology of hip pain in adults (e.g., history, careful clinical and radiographic examination), will help identify the majority of clinically important pathologies which can cause hip pain. Conservative treatment and selective use of injection therapies has proven quite successful for the treatment of most causes of hip pain.

Sacroiliitis and sacral insufficiency fracture: A rare coexistence

Sacral insufficiency fracture (SIF) is an uncommon cause of hip and back pain. Sacroiliitis, often a feature of inflammatory conditions of spinal column, is inflammation of sacroiliac joints. Herein, we report a 41-year-old woman presenting with a SIF and sacroiliitis as a part of non-radiographic axial spondyloarthritis.

Idiopathic Rotational Abnormalities of the Lower Extremities in Children and Adults.

* Rotational malalignment of the lower extremity is a potential cause of hip, knee, and ankle pain.* Physical examination must include observation of gait and an assessment of femoral rotation and the thigh-foot axis with the patient prone.* Advanced imaging helps to quantify the degree of deformity, improving the accuracy of the preoperative plan.* Surgical correction of rotational malalignment of the femur and tibia is reserved for severe, symptomatic deformity.* Future software that allows for 3-dimensional assessment of alignment and preoperative planning will further aid in the correction of the complex deformities.

Periprosthetic acetabular radiolucency progression in mid-term follow-up of the articular surface replacement hip system.

Recent registry studies show that aseptic loosening secondary to osteolysis is the second leading cause of hip implant failure in patients implanted with metal-on-metal (MoM) bearings. The primary aim of our study was to report on the progression of acetabular osteolysis during mid-term follow-up in patients treated with MoM hip resurfacing arthroplasty (HRA) and MoM total hip arthroplasty (THA). The secondary aim was to identify independent predictors of osteolytic lesion progression. A total of 805 patients (805 hips) were included in this study (541 MoM HRA, 264 MoM THA) from a prospective, international clinical registry of the Articular Surface Replacement Hip System. Patients were enrolled a median of 6.6years from surgery. Osteolytic lesion progression was defined either as any lesion developing de novo, or as an existing lesion progressing from radiolucency to osteolysis during the study period (range 0.5-4.3years). The number of cases with any osteolysis or radiolucency was 21 (3.9%) for ASR HRA and 29 (11.0%) for ASR XL THA at enrollment and increased to 69 (12.8%) for ASR HRA and 41 (15.5%) for ASR XL THA after follow-up. Osteolytic lesion progression was found in 66 (12.2%) ASR HRA patients and 31 (11.7%) ASR XL THA patients. Multivariate models determined that lower acetabular version angle (OR 0.963, p = 0.011) and elevated whole blood chromium (OR 1.110, p = 0.044) were independent predictors of osteolytic lesion progression in ASR HRA. We suggest that physicians of patients implanted with ASR HRA implants closely monitor patients with higher chromium levels and lower version angles, as they are at increased risk for osteolytic lesion progression, and we recommend annual radiographic follow-up on all patients with ASR implants.

Differences in Hip Joint Biomechanics and Muscle Activation in Individuals With Femoroacetabular Impingement Compared With Healthy, Asymptomatic Individuals: Is Level-Ground Gait Analysis Enough?

Background:Femoroacetabular impingement (FAI) is a recognized cause of hip and groin pain and a significant factor in hip joint function during sport. Objective tests for understanding hip function are lacking in this population.Purpose:To determine whether biomechanical and electromyographic features of hip function during level-ground walking differ between a group diagnosed with FAI and those with no symptoms of FAI.Study Design:Controlled laboratory study.Methods:A total of 20 asymptomatic individuals and 20 individuals with FAI walked on a dual-belt instrumented treadmill at self-selected walking velocities. Sagittal and frontal plane joint motions, moments, and muscle activation for the gluteus medius, gluteus maximus, rectus femoris, and medial and lateral hamstrings were analyzed. Discrete measures were extracted from each biomechanical waveform, and principal component analysis was used to determine hip joint muscle activation and hip adduction moment patterns. Statistical significance was determined by use of Student t tests with Bonferroni adjustments for multiple comparisons (α = .05).Results:Individuals with FAI walked more slowly (P = .015) and had lower self-reported function (P < .001). No differences in muscle strength were found between the symptomatic and contralateral legs in the FAI group (P > .017), but those with FAI had lower strength in the knee extensors and flexors and the hip extensors, flexors, and adductors compared with the asymptomatic group (P < .017). Individuals with unilateral symptomatic FAI walked with similar biomechanical and hip muscle electromyographic results bilaterally. The only differences found were a greater amplitude of gluteus maximus activation in the FAI symptomatic leg compared with the asymptomatic group and greater medial hamstring activation than lateral hamstring activation in the FAI group in both limbs compared with the asymptomatic group.Conclusion:Individuals with FAI were generally deconditioned and reported significantly more functional limitations. No biomechanical differences existed between groups during level walking, yet hamstring and gluteus maximus activation differed when the symptomatic group was compared with the asymptomatic group.Clinical Relevance:The field lacks objective testing of hip joint function to understand implications of FAI for dynamic movements, particularly with applications to biomechanics and electromyography. Level walking was of limited value for understanding FAI hip function, and the development of a more challenging gait assessment is warranted.

Can Ultrasound Accurately Assess Ischiofemoral Space Dimensions? A Validation Study

BackgroundIschiofemoral impingement is a potential cause of hip and buttock pain. It is evaluated commonly with magnetic resonance imaging (MRI). To our knowledge, no study previously has evaluated the ability of ultrasound to measure the ischiofemoral space (IFS) dimensions reliably. ObjectiveTo determine whether ultrasound could accurately measure the IFS dimensions when compared with the gold standard imaging modality of MRI. DesignA methods comparison study. SettingSports medicine center within a tertiary-care institution. ParticipantsA total of 5 male and 5 female asymptomatic adult subjects (age mean = 29.2 years, range = 23-35 years; body mass index mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. MethodsSubjects were secured in a prone position on a MRI table with their hips in a neutral position. Their IFS dimensions were then acquired in a randomized order using diagnostic ultrasound and MRI. Main Outcome MeasurementsThe main outcome measurements were the IFS dimensions acquired with ultrasound and MRI. ResultsThe mean IFS dimensions measured with ultrasound was 29.5 mm (standard deviation [SD] 4.99 mm, standard error mean 1.12 mm), whereas those obtained with MRI were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). The mean difference between the ultrasound and MRI measurements was 1.25 mm, which was not statistically significant (SD 3.71 mm, standard error mean 3.71 mm, 95% confidence interval −0.49 mm to 2.98 mm, t19 = 1.506, P = .15). The Bland-Altman analysis indicated that the 95% limits of agreement between the 2 measurement was −6.0 to 8.5 mm, indicating that there was no systematic bias between the ultrasound and MRI measurements. ConclusionsOur findings suggest that the IFS measurements obtained with ultrasound are very similar to those obtained with MRI. Therefore, when evaluating individuals with suspected ischiofemoral impingement, one could consider using ultrasound to measure their IFS dimensions. Level of EvidenceIII

Si3N4 as a biomaterial and its tribo‐characterization under water lubrication

AbstractHip implant wear is recognised as the main cause of hip implant failure therefore has been widely investigated both experimentally and clinically, demonstrating the coexistence of abrasive, adhesive, fatigue and corrosive wear. Many clinical in vivo and bulk material wear rate data from published literature have been presented for non‐oxide ceramic implants. Several studies have shown that the coefficient of friction of self‐mated silicon nitride in water decreases from an initially high value to about 0.002 after a certain run‐in period. Since the worn surfaces become extremely smooth, the low friction is attributed to the initiation of hydrodynamic lubrication by a thin water film at the interface. The possibility of mixed lubrication, i.e. hydrodynamic lubrication by water and boundary lubrication due to the presence of colloidal silica on the wearing surfaces, has also been proposed.Influence of load, speed and surface roughness on the duration of the run‐in period of silicon nitride under water lubrication was investigated in this study. The results confirmed that a low coefficient of friction is obtained following a run‐in period when a wear scar of sufficient size is developed to reduce the contact stress. The run‐in period, during which the coefficient of friction is fairly high, is shorter for smoother surfaces and at higher loads and speeds. The striations that appeared to be associated with the high‐friction spikes can be formed as a result of surface film breakdown. Although the results are consistent with the proposed mechanisms of hydrodynamic lubrication or mixed lubrication, it is proposed that the low‐friction behaviour may also be related to fundamental interactions between two hard and elastically deforming surfaces covered with hydrogen‐terminated oxide films. Copyright © 2016 John Wiley &amp; Sons, Ltd.

Physiotherapy management of knee and hip osteoarthritis: A survey of patient and medical practitioners’ expectations, experiences and perceptions of effectiveness of treatment

Osteoarthritis (OA) is a common cause of hip and knee pain. Current research advocates physiotherapy as an effective form of treatment to help manage OA. The aim of the study was to investigate the self-reported behaviour, experiences, expectations, and perceptions of general practitioners (GPs), orthopaedic surgeons, and patients with regard to physiotherapy referral and management of individuals with OA of the hip and knee. A survey questionnaire was designed to gather this information. A total of 98/320 (30% response rate) participants with hip or knee OA responded. Twenty four GPs from a pool of 52 (46%), and 20/76 orthopaedic surgeons (26%) responded. Fifty-one percent of participants with OA had received physiotherapy with the majority being referred by their GP or surgeon. Common interventions applied by physiotherapists appeared to be in keeping with best practice evidence. The 49% of participants who did not receive physiotherapy were not given an indication of the benefits of treatment from physiotherapists. Those participants with OA of the hip and knee who had good access to physiotherapy services, were receiving treatment in keeping with current best practice. GPs do regularly refer patients to physiotherapy but less so orthopaedic surgeons. Further improvements in referral patterns may be possible by increasing awareness of the benefits of exercise and physiotherapy management for OA.

Multiple hereditary exostoses and ischiofemoral impingement: a case-control study.

To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55% were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62%) hips in the MHE group and 0/21 (0%) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change.

FRI0207 Prevalence of Femoroacetabular Impingement in Caucasians Compared to Chinese in Vancouver, Canada: A Population-Based Study

BackgroundFemoroacetabular Impingement (FAI) is one source of hip pain in young adults and has been suggested as a major cause of hip osteoarthritis (OA). The prevalence of radiographic hip OA...

Neuroblastoma

Neuroblastoma is the most common solid extracranial tumor of childhood. Even though >25% of presentations are orthopaedic in nature, ranging from a limp to lower limb paralysis, neuroblastoma is a rare cause of limping in childhood and can therefore be easily missed by the admitting orthopaedic surgeon. Four cases of metastatic neuroblastoma are reported who all presented with hip pain within the last 3 years at Royal Manchester Children's Hospital. They all posed a diagnostic dilemma and an alternative diagnosis was initially made. A simple screening examination of the abdomen after ultrasonographic hip examination for sepsis would have led to an earlier diagnosis in all 4 cases. We suggest that including the abdomen in children undergoing a hip sonographic examination in those who are slightly atypical in nature or have indications of malignancy may lead to an early diagnosis of this rare cause of hip pain. IV.

Bilateral Acetabular Fractures in an Adolescent After Low-Energy Trauma

Pediatric pelvic fractures are rare, accounting for approximately 2.4% to 5.5% of annual admissions at large level I trauma centers. An acetabular fracture is involved in only about 1% to 15% of these cases and is almost exclusively caused by a high-energy trauma. This is a report of an otherwise healthy 15-year-old male adolescent who sustained a nondisplaced bilateral anterior column and wall acetabular fracture after a low-energy mechanism during a hockey game. The patient was managed nonoperatively with non-weight-bearing restrictions and had complete resolution of his symptoms by 10 weeks. This case shows that a low-energy mechanism can create significant bilateral acetabular fractures in the immature skeleton. The presented case may represent an underdiagnosed cause of hip and groin pain in the adolescent patient/athlete when initial radiographs appear normal.

A numerically validated probabilistic model of a simplified total hip replacement construct

Hip replacement constructs are paradigms of uncertain systems, and as such are suited to the application of probabilistic methods to assess their structural integrity. In order to gain confidence in a probabilistic model, it would be useful to verify the findings with experimental data; however, this is difficult to achieve in practice because of the exhaustive number of parameter combinations that need to be tested. As an alternative to experimental testing, benchmarking can be carried out provided a known analytical solution is available. To this end, a simplified 2D two-beam model of the femoral part of a total hip replacement construct was utilised to analyse uncertainties and variability in the construct as it is subjected to load. The use of a simplified model enabled geometric parameters to be investigated; these are commonly not considered in probabilistic models due to the increased complexity involved. Analytical and finite element representations of the model were developed and compared. The probabilistic study used the Monte Carlo simulation technique and the first-order reliability method to look at the inducible displacement of a hip implant, a phenomenon that has been linked to the most common cause of hip implant failure, aseptic loosening. Excellent correlation was observed between the analytical and probabilistic solutions, and it was shown that probabilistic approaches could efficiently predict the response of the simplified beam model while readily identifying the parameters most likely to compromise the structural integrity of the construct.