Examination Of Hip Research Articles

Dynamic Hip Examination for Assessment of Impingement During Hip Arthroscopy

Arthroscopic procedures for treatment of hip pathology are growing exponentially as a result of continued improvements in the understanding of intra- and extra-articular hip anatomy and technological advancements in instrumentation. Nevertheless, it has been reported that the main cause of revision hip arthroscopy is related to a suboptimal intrasurgical management of the abnormal morphology in femoroacetabular impingement (FAI). Under-resection, over-resection, and in some cases combined under-resection and over-resection at different locations of the cam lesion at the femoral head-neck junction may lead to poor outcomes as a result of residual impingement or the iatrogenic creation of structural instability. Thus, an intraoperative assessment technique capable of revealing in real time the effect of the resection is vital for a successful procedure. Therefore, we present a technical note describing our preferred method to dynamically assess overall hip range of motion, motion at risk, and evaluation of the osteoplasty after surgical correction of FAI.

CORR Insights®: What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

CORR Insights®: What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

Osteopenic features of the hip joint in patients with cerebral palsy: a hospital-based study.

We aimed to evaluate the bone mineral density of the hip joint in patients with cerebral palsy (CP). Patients with CP younger than 18 years who underwent three-dimensional hip examination by computed tomography were analysed. Bone attenuation of the acetabulum and femur was measured as Hounsfield units (HU), and was adjusted for affecting factors such as hip instability and Gross Motor Function Classification System (GMFCS). One hundred and twenty-six patients with CP and 86 typically developing participants were included. The average bone attenuation was significantly lower in those with CP than in the comparison group (acetabulum: 70.8HU, 95% confidence interval [95% CI] 59.9-81.8; femur: 82.2HU, 95% CI 70.4-95.8). Compared with GMFCS levels I to III, bone attenuation was significantly lower for GMFCS levels IV (acetabulum: 30.9HU, 95% CI 15.7-46.2; femur: 39.7HU, 95% CI 19.9-59.5) and V (acetabulum: 51.7HU, 95% CI 35.9-67.5; femur: 72.5HU, 95% CI 51.9-93.0). The average bone attenuation decreased when the migration percentage was over 37% (acetabulum: 11.6HU, 95% CI 1.4-24.6; femur: 26.8HU, 95% CI 9.9-43.6). Bone attenuation of the acetabulum and femur was significantly affected both by GMFCS level and by severity of hip instability.

Disruptive Knee Pain in a Cross Country Runner

HISTORY: An 18 year old male cross country runner presented to the office for non-radiating sharp lateral right knee pain. He was running approximately 20 miles per week. His pain progressively worsened over the past 10 months and he could no longer run. He had no pain at rest or while walking, and no locking, clicking, snapping, or buckling. His knee did swell mildly the last time he ran. There was no trauma and he never experienced any back or hip pain. He was initially seen by his PMD who diagnosed him with a knee sprain and prescribed physical therapy (PT), rest, ice, naproxen, and ordered an MRI. The MRI showed a trace knee effusion, but was otherwise negative. After completing PT with no relief, he was referred to a sports medicine orthopedist who diagnosed him with IT band friction syndrome and continued PT with rest. He did not improve and had a landmark based cortisone injection into the distal IT band with no relief. PHYSICAL EXAMINATION: Right knee exam: normal alignment and gait, no effusion, and tender lateral joint line. Quadriceps and hamstring strength was 4/5 with 100 loss of flexion. Positive Noble’s and McMurray test. All other provocative tests were negative, including Ober. Hip exam normal DIFFERENTIAL DIAGNOSIS: IT band syndrome Occult lateral meniscus tear Patellofemoral pain syndrome Loose body TEST AND RESULTS: MRI T2 STIR images showed a subtle signal abnormality between the IT band and the lateral femoral condyle consistent with IT band friction syndrome and a minimal linear signal abnormality posterior of the lateral meniscus junction within the distal strut in the popliteus hiatus of indeterminate significance. The posterolateral corner structures were normal. A dynamic study of an ultrasound guided cortisone injection into the distal IT band insertion and then running directly afterward and at one week produced no relief. An intra-articular lidocaine injection and running directly afterward produced complete resolution of symptoms. FINAL WORKING DIAGNOSIS: Meniscal capsular disruption TREATMENT AND OUTCOMES: He had a knee arthroscopy that repaired the meniscal capsular junction tear and a hypermobile lateral meniscus. After repair, bone marrow aspirate concentrate was injected into the posterior lateral capsule. He completed post-operative PT and is now long distance running pain-free.

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey.

Background:Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.Methods:A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.Results:NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.Conclusions:Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.

Prevalence and Functional Consequences of Femoroacetabular Impingement in Young Male Ice Hockey Players

Background: Femoroacetabular impingement (FAI), which is highly prevalent in adult ice hockey players, is often associated with negative clinical and functional outcomes. It is unclear, however, whether FAI-related bony deformities and symptoms may lead to functional alterations as reflected in hip muscle strength, range of motion (ROM), and on-ice physical performance in youth ice hockey players. Hypothesis: Compared with players with neither structural signs nor symptoms related to FAI, players with symptomatic FAI would show hip muscle weakness and reduced hip ROM, which would in turn affect ice hockey physical performance. Study Design: Controlled laboratory study. Methods: A total of 74 young male ice hockey players were evaluated bilaterally for passive hip internal rotation ROM by use of a hip examination chair. Only the side with less internal rotation ROM was further investigated. FAI-related bony deformities were evaluated with magnetic resonance imaging (MRI). The involved hip was classified as symptomatic or asymptomatic based on the presence of hip pain during exercise and results from the flexion/adduction/internal rotation (FADIR) provocation test. Hip muscle strength, passive hip ROM, and on-ice physical performance were compared between players with no FAI, players with asymptomatic MRI-positive FAI, and players with symptomatic FAI. Results: Fifty of 74 players (68%) had FAI-related bony deformities, of whom 16 (22%) were symptomatic. Hip muscle strength, hip ROM, and on-ice physical performance did not differ significantly between players with no FAI and those with asymptomatic or symptomatic FAI. Conclusion: Despite a high prevalence of FAI-related bony deformities, youth ice hockey players with asymptomatic or symptomatic FAI did not show functional impairments in terms of hip muscle strength, hip ROM, or on-ice physical performance. Clinical Relevance: Hip muscle strength, passive hip ROM, and on-ice physical performance do not seem to discriminate for FAI-related signs and symptoms in young male ice hockey players.

A MISSED DIAGNOSIS OF ASYMPTOMATIC SIMULTANEOUS BILATERAL FRACTURE NECK FEMUR DUE TO VITAMIN D DEFICIENCY TREATED AS SEVERE BILATERAL OSTEOARTHRITIS KNEE: HOW TO PREVENT IT?

Simultaneous bilateral neck of femur fracture is a rare injury and poses a diagnostic challenge. This uncommon pattern of injury has been associated with high-energy trauma and seizure disorders. Proper clinical examination of both hip and knee joint should be performed in patients presenting with bilateral knee pain. Clinical suspicion and detailed radiologic evaluation of both hip and knee joint is essential for diagnosis of uncommon injury around hip joint. A battery of metabolic tests to assess vitamin D deficiency and histology study of the specimen should be performed. Patients with simultaneous bilateral fracture neck femur can be treated well and perform activities of daily living with good outcomes with prompt surgical intervention and medical treatment. We report the case of asymptomatic simultaneous bilateral neck of femur fracture following vitamin D deficiency which was missed and was misdiagnosed and treated for severe bilateral osteoarthritis knee.

Ultrasound in Detection of Developmental Hip Dysplasia in Premature Born Children

Introduction:Developmental hip dysplasia represents the most common deformation of locomotor system in children. Developmental modulation of the hip is expressed during first year of life which is important for early diagnosis and treatment. Therefore, in the practice, it is very important to set a diagnosis early with application of simple and convenient methods (ultrasound) in order to achieve fast and efficient therapeutical effect and avoid permanent disability.Aim:The aim of this paper is to point out the increase of prematurely born infants and their survival thanks to the development of Unit for Intensive Neonatal Care at the Pediatric Clinics in Sarajevo.Material and methods:Clinical investigation included 150 infants (77 girls and 73 boys) in whom the developmental hip dysplasia was diagnosed with clinical exam, ultrasound exam and x-ray of the hips. The exams were done in period of January 2012 to August 2014.Results:Two groups of patients were formed. The first one consisted of premature infants, total number of 75 (34 girls and 41 boys), with developmental hip dysplasia that was diagnosed at the first exam at the Ultrasound unit of the Pediatric clinics and at the Intensive Neonatal Care Unit of the Pediatric Clinics in Sarajevo. Second (control) group consistsed of patients-on term infants who had diagnosed one of developmental hip dysplasia, total of 75 (43 girls and 32 boys) during first exam in the Ultrasound unit of the Pediatric clinics in Sarajevo.Conclusion:The frequency of premature birth is between 5 and 10% of all labors and demonstrates increasing trend. We suggest ultrasound examination of hips in each newborn, term or premature, at the age of 6 weeks after birth.

Evaluation of children with flatfoot on the basis of clinical features, footprint analysis and imaging studies

Introduction: There is no consensual agreement on the strict clinical or radiographic criteria for defining a flatfoot. Traditionally, a flatfoot has been defined subjectively as a weight-bearing foot with an abnormally low or absent longitudinal arch. This definition is based solely upon the static anatomic comparison of the height of the arch within a population. It fails to take into consideration the etiology of the flatfoot, the functional relationships between the bones, and the presence or evidence-based expectation of future pain or disability. Methodology: All patients in the study were evaluated thoroughly using detailed history and complete physical examination with special emphasis on weight, family history, findings like tight tendoachilles, ligamentous laxity, intermalleolar distance and gait analysis. The examination included biomechanical examination of hip, knee, foot and ankle. Associated conditions were also given importance to rule out any syndromic flat foot. Results: The younger the age group the better they respond to orthotic treatment. More severe the deformity the better they respond to orthotic treatment. Symptomatic fff have better results than asymptomatic fff. Early the orthotic treatment received better is the result. Arch support helps in relieving clinical features like pain and out toeing. Conclusion: Arch index may help in improvement of radiographical angles like cp, tca and tma. There is no short term and long term complications related to using of arch support. Keywords: Flatfoot, Arch index, Radiology, Tendoachilles

Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia.

PurposeOne goal of neonatal screening for developmental dysplasia of the hip (DDH) is the prevention of late surgery. However, the majority of patients with acetabular dysplasia at skeletal maturity are not diagnosed with DDH during infancy. Selective ultrasound screening may identify patients with neonatal hip instability, but may be ineffective for the prevention of dysplasia presenting in adulthood. The purpose of this study is to identify the prevalence of risk factors for DDH that would have warranted selective ultrasound screening in patients with symptomatic acetabular dysplasia after skeletal maturity.MethodsA prospective hip specialty center registry was used to identify 68 consecutive skeletally mature patients undergoing corrective osteotomy for symptomatic acetabular dysplasia. Risk factors for DDH evaluated in all patients included sex, family history of hip osteoarthritis or DDH, breech, method of delivery, previous hip treatments, and birth order. Radiographs [lateral center edge angle (CEA), anterior CEA, Tönnis grade, and Tönnis angle] were measured preoperatively.ResultsSixty-seven females and one male were identified. No patients were previously diagnosed with DDH or received treatment for their hips. The majority of patients (85.3 %) did not meet selective ultrasound screening guidelines following a stable neonatal hip exam and, therefore, would not have been screened in a selective screening program. Of the findings outside of screening guidelines, 98.5 % were females, 52.9 % were first born, and 36.8 % had a family history of hip osteoarthritis.ConclusionsThe majority (85.3 %) of patients with symptomatic acetabular dysplasia at skeletal maturity would not have met current recommendations for selective ultrasound screening in the USA had they been born today.

MR imaging of transient osteoporosis of the hip: An update on 155 hip joints

PurposeTransient osteoporosis of the hip (TOH) presents with acute onset pain and bone marrow edema (BMe) on MR imaging. The purpose of this study is to revise the MR imaging characteristics of TOH by analyzing the data derived from 155 hip examinations. We also sought to explore the relationship between the duration of symptoms and the presence of sparing and subchondral fractures. Materials and methodsMR images of 155 hips (141 TOH patients) were retrospectively evaluated for the presence of insufficiency fractures and the morphology of BMe. Sparing of the medial bone marrow of the femoral head was recorded together with demographic and clinical data. Progression to regional migratory osteoporosis (RMO) and postpartum cases were also recorded. ResultsOur population consisted of 76.4% male and 23.6% female patients. RMO progression was recorded in 19.4% and 4 postpartum cases displayed bilateral disease. Sparing of the medial bone marrow was present at 87.7% of patients and disappeared as the disease progressed (P=0.005). BMe was restricted within the femoral head in 11.0%, extended to the femoral neck in 40% and to the femoral shaft in 49% of the cases studied. Subchondral fractures were present at 48.7% of the hips. ConclusionThis study describes TOH patient characteristics, the MR imaging findings (BMe pattern, microfractures), their association with symptom duration and the chance of progressing to RMO.

Prevalence of femoro-acetabular impingement in international competitive track and field athletes.

The aim of our study was to analyse the prevalence of femoro-acetabular impingement (FAI) in national elite track and field athletes compared to peers using magnetic resonance imaging (MRI) and clinical examination including impingement tests. A total of 44 participants (22 national elite track and field athletes and 22 non-athletes) underwent an MRI for radiological findings associated with FAI, including alpha angle, lateral centre edge angle (CEA), findings of labral and cartilage lesions. The study group was furthermore investigated by the hip outcome score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests. Concerning the cam impingement, there was a significant difference measured by mean alpha angle between the athlete group (52.2 ± 7.29°) and the control group (48.1 ± 5.45°, P = 0.004). Eleven athletes showed a cam impingement, while two probands of the control group had a pincer impingement and one a mixed form (P = 0.0217). There was no statistically significant difference concerning the CEA upon evaluating pincer impingement. Seven track and field athletes had a positive impingement test, whereof three had an increased alpha angle >55°. No participant of the control group showed pathological results in the impingement test (P = 0.0121). MRI evidence and clinical examination suggest that cam impingement is more common in elite athletes in comparison to non-athletes. At a professional level, the intense practice of track and field athletics is susceptible for FAI.

Changes in the Hip of Youth Hockey Players over 3 Seasons as Seen on MRI and Physical Exam

Objectives:It has been reported that relative to other sports participants, ice hockey players suffer from cam femoroacetabular impingement (FAI) in higher numbers. Alpha angles have been reported to increase with the likelihood of symptomatic FAI. It is unclear how alpha angle and other factors related to FAI change over early childhood years. The objective of this study was to track youth hockey players over 3 years and determine if factors associated with FAI increased as they aged and increased skating time.Methods:15 asymptomatic youth ice hockey players(ages 10 to 16 years) had pre-participation screening prior to starting youth hockey season. All players started in the peewee(ages 10 to 12) division and moved up in divisions over the 3 years. All players had a clinical hip examination consisting of the FABER test, impingement testing, and measurement of hip internal rotation. An limited screening MRI was taken and the hip alpha angle was measured and labral tears were documented.Results:These youth hockey players played an average of 42 weeks/year over 3 years. Four goalies were included. Players had significantly increased alpha angle by year 3 of screening. The average alpha angle at year 1 was 56(range 45 to 63), year 2 average was 59 (range 52 to 68) and year 3 average was 75 (range 64 to 88). By year 3, 12/15 had asymptomatic labral tears. The 3 players who did not have labral tears had alpha angles of 60, 62, and 64 degrees. There were no significant changes in internal rotation over the 3 years. There was a trend toward decreased internal rotation in goalies. One goalie reported symptoms after the completion of the 3 rd season when he was 16 years old.Conclusion:Young ice hockey players show increasing alpha angles and development of asymptomatic labral tears. Stresses inherent to ice hockey likely enhance the development of a bony overgrowth on the femoral neck contributing to cam FAI. Further study into the etiology of the increase in the alpha angle in ice hockey players is recommended to determine if preventative measures may be adapted to decrease the incidence of hip symptoms which decrease activity level.

Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players

Femoroacetabular impingement (FAI) represents a novel approach to the mechanical etiology of hip osteoarthritis. The cam-type femoroacetabular impingement deformity occurs frequently in young male athletes. The aim of our study was to evaluate the prevalence of FAI in male semiprofessional soccer players using clinical examination and magnetic resonance imaging (MRI), compared to amateur soccer players. In MRI, the α angle of Nötzli is determined for quantifying FAI. According to power analysis, a total of 22 asymptomatic semiprofessional soccer players with a median of 23.3 years of age (range 18-30 years) and 22 male amateur soccer players with a median of 22.5 years of age (control group, range 18-29 years) underwent an MRI to measure the hip α angle of Nötzli. The α angle of the kicking legs of the semiprofessional group and the amateur group were analyzed. The study group was moreover evaluated by the Hip Outcome Score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests. In the semiprofessional group, 19 soccer players had a right kicking leg and 1 soccer player had a left kicking leg. 2 soccer players kicked with two feet. In the semi-professional group, the mean value of the α angle of the kicking leg (57.3 ± 8.2°) was significantly higher than in the amateur group (51.7 ± 4.8°, P = 0.008). In the semi-professional group, 15 (62.5 %) of 24 kicking legs had an increased α angle >55°, while 5 (27.3 %) kicking legs of the amateur group had an α angle >55°. Five semi professional soccer players had findings in clinical examination, whereof 4 had an increased α angle >55°. No participant of the amateur group showed pathological results in the clinical examination (P = 0.0484). Overall, semiprofessional soccer players had a higher proportion of an increased α angle than the amateur group. Semiprofessional players have a higher prevalence of an increased α angle in the kicking leg than the amateur group at the same age. The kicking leg is predisposed for FAI.

Pseudotumor After Bilateral Ceramic-on-Metal Total Hip Arthroplasty: A Case Report.

Multiple studies have been published on high revision rates for metal-on-metal (MoM) total hip arthroplasty as a result of early failures and pseudotumor formation1-4. The use of MoM articulations has decreased dramatically, and other hard-on-hard bearings have been promoted. The pathogenesis of pseudotumor formation is unknown, although this adverse local tissue reaction has demonstrated histologic features thought to reflect a hypersensitivity response (metallosis) to cobalt and/or chromium particles1,5-8. High serum levels of these metals are positively correlated with the angle of inclination of the acetabular component, presumably due to the resultant edge loading and high wear9-12. We report a case of massive pseudotumor formation in a patient who had undergone bilateral ceramic-on-metal (CoM) total hip arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. In February 2009, a seventy-one-year-old woman had undergone bilateral cementless total hip arthroplasty with CoM articulation via an anterior supine intermuscular approach at another facility. A modular uncemented porous-coated cup with a cobalt-chromium (CoCr) liner and a 36-mm Biolox delta ceramic head (Biomet, Warsaw, Indiana) were used. Postoperatively, two dislocations of the right hip had occurred, one in November 2010 and one in October 2011. In December 2011, the patient visited the outpatient clinic of our hospital with pain in the right groin and audible crepitations during movement of the right hip. The patient had a body mass index of 26 kg/m2. Examination of the right hip showed flexion of 110°, external rotation of 40°, and internal rotation of 30°. Clear crepitations were audible during flexion and extension; no mass was palpable. An acetabular anteversion angle of 38° and an inclination angle of 57° were estimated from the anteroposterior radiograph …

The Hip Lag Sign - Prospective Blinded Trial of a New Clinical Sign to Predict Hip Abductor Damage

This study introduces and validates the Hip Lag Sign, a new clinical parameter to determine hip abductor damage, which appears to be one major cause for greater trochanteric pain syndrome. 26 patients who underwent standardized MRI-examination were prospectively enrolledbetween October 2009 and March 2012. A standard physical examination of the hip was performed, including the Hip Lag Sign as it is defined for the first time in this work. Hip Lag Sign results were statistically compared toMR images, to pain levels measured with the visual analogue scale and to results of the modified Harris Hip Score as a universal and well established diagnostic tool for the hip. Chi2- and Mann-Whitney-U-analysis were applied. Diagnostic accuracy was tested with 2×2-table-calculations.Kappa statistics were used to analyze inter-observer variability. A positive Hip Lag Sign is significantly associated with MRI-proven hip abductor damage (p<0.001). The Hip Lag Sign has a sensitivity of 89.47% and a specificity of 96.55%. The positive and negative predictive values are 94.44%, resp. 93.33%. Its diagnostic Odds Ratio is 239.000 (p<0.001; 95%-CI: 20.031-2827.819). The number needed to diagnose was 1.16.Inter-observer consistency was 98.1% and kappa statistics for inter-observer variability were 0.911. The Hip Lag Sign is specific and sensitive, easy and fast to perform and allows a reliable assessment on the hip abductors' status, especially when there is no access to further diagnostic devices such as MRI for example due to restricted resources like in developing countries. Thus, we recommend the inclusion of the Hip Lag Sign into everyday hip examinations, especially dealing with patients suffering from greater trochanteric pain syndrome.

Screening for hip dysplasia in congenital muscular torticollis: Is physical exam enough?

PurposeAn association between congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) has been established in the literature; however, whether the screening of patients with CMT for DDH requires hip imaging remains controversial. The purpose of this study is to determine (1) the coexistence rate of DDH requiring treatment in individuals with CMT and (2) if physical exam alone is sufficient screening.MethodsA single-center retrospective chart review was performed among 97 consecutive patients between 1/1/2003 and 9/1/2012 with CMT who had hip imaging performed.Results12 % (12/97) of patients with CMT had DDH, all requiring treatment. 75 % (9/12) of the patients with DDH had an abnormal clinical exam. Of the three patients with DDH and a normal clinical exam, two patients were presenting for a second opinion after being treated for DDH prior to evaluation. 90 % (9/10) of patients with DDH at the time of presentation had an abnormal hip exam. All 12 patients with hip dysplasia were referred for DDH or DDH with CMT. There were no patients who were referred for CMT alone that had DDH.ConclusionsIn the care of a patient with CMT, it is important that the clinician remains vigilant about screening for DDH. An ultrasound or radiograph of the hips should be strongly considered as part of the evaluation of a child with CMT.Level of evidence: IV.

Clinical significance of signal changes in the quadratus femoris muscle on MR

To evaluate the clinical significance of quadratus femoris muscle signal changes (QFMC) on MRI. 204 consecutive bilateral MRI hip examinations (132 female, 72 male) were reviewed in retrospect for QFMC. Inclusion imaging parameters were edema or atrophy of the quadratus femoris muscle. The presence or absence of symptoms and additional ipsilateral and/or contralateral imaging findings were used to differentiate between isolated symptomatic, co-incidental and asymptomatic QFMC. 24 (11.8%) patients and 30 (7.3%) hips demonstrated QFMC. Atrophy was present in 5 symptomatic hips. Female to male ratio was 23:1. Isolated symptomatic QFMC: 4 hips (13.3%), 1 bilateral. Clinical symptoms in this group were non-specific greater trochanter pain and stiffness of the hip. Co-incidental QFMC: 19 symptomatic hips, ipsilateral associated findings present in 18 hips (94.7%) and contralateral additional findings present in 8 hips (42.1%). Asymptomatic QFMC: 7 hips (23.3%), ipsilateral associated asymptomatic findings in 5 hips (71.4%) and contralateral associated symptomatic findings in 6 hips (85.7%). Edema around the greater trochanter and hamstring insertions were the most frequent associated findings. In this study, most cases of QFMC were co-incidental or asymptomatic. In isolated symptomatic QFMC clinical complaints were non-specific. Atrophy was found only in the symptomatic hips.

Hip displacement in relation to age and gross motor function in children with cerebral palsy

PurposeHip dislocation in cerebral palsy (CP) is a serious complication. By radiographic screening and prophylactic surgery of children at risk most dislocations can be prevented. CPUP, the Swedish CP registry and follow-up program, includes annual radiographic examinations of children at Gross Motor Function Classification System (GMFCS) levels III–V. Data from CPUP were analysed to assess the risk of hip displacement in relation to GMFCS levels and age.MethodsAll children at GMFCS levels III–V (N = 353) whose first radiographic screening occurred before 3 years of age were followed between the ages 2–7 years. Migration percentages (MPs) were recorded annually (1,664 pelvic radiographs) and analysed using discrete time survival analysis.ResultsThe risk of hip displacement between 2 years and 7 years of age was significantly (p < 0.05) higher for children at GMFCS level V during the entire study period. The risk was highest at 2–3 years of age and decreased significantly (p < 0.001) with each year of age (OR = 0.71, 95 % CI 0.60–0.83). The cumulative risk at age 7 years for those at GMFCS V for MP ≥ 40 % was 47 % (95 % CI 37–58). The corresponding risk at GMFCS IV was 24 % (16–34) and at GMFCS III 23 % (12–42).ConclusionsChildren at GMFCS V have a significantly higher risk of hip displacement compared with children at GMFCS III–IV. The risk is highest at 2–3 years of age. The results support a surveillance program including radiographic hip examinations as soon as the diagnosis of severe CP is suspected.

The Role of MRI in the Evaluation of Painful Hip Joint (MRI of Hip Joint)

This study aim to evaluate the diagnostic value of MRI in assessment of painful hip joint. Background: Radiographic evaluation is crucial in patients with painful hip joint. Hip pain has different etiologies in adults and children. MRI is the method of choice in characterizing the various disorders and assessing the full extent of osseous, chondral and soft tissue abnormality of the hip joint. Methods: This prospective study included 100 patients with painful hip joint. The following MR sequences were performed to all patients: Coronal T1, T2 & STIR WIs, axial T1&T2WIs, axial T1WI and sagittal T1WI after contrast injection. Patient's history, local examination of the diseased hip and laboratory investigations were performed. Results: Male to female was 45 to 55, their ages ranged from 10 to 60 years with a mean age of 35 years. The MRI sensitivity were as follows 88% in avascular necrosis, 80% in osteoarthritis,90% in migratory osteoporosis, 100% in transient synovitis, 72% in septic arthritis, 80% in Perthe's disease, 80 % in tumor, 100% in inflammatory lesions 75% in slipped femoral epiphysis and 100% in stress fractures . Conclusion: MRI of the hip joint is an informative, diagnostic, and accurate for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.