Hip Joint Space Research Articles

Arthroscopic Bullet Removal From the Central and Peripheral Compartments of the Hip Joint

Recent advances in hip arthroscopy offer an approach for treating an uncommon but highly disabling injury from intra-articular missile injury to the hip. Hip arthroscopy affords the patient the benefit of minimally invasive surgery while allowing for the diagnosis and treatment of concomitant pathology, which may be either acute, from the trauma of the missile, or chronic. We present a technique for the removal of projectiles from the central and peripheral compartments of the hip joint. Through a surgical series of a variety of gunshot wounds, we detail the unique aspects of retrieval for the various missile endpoints. We describe this technique for bullets or pieces of bullets lodged within the hip joint space, bone of the acetabulum, or femoral head. Furthermore, we provide an example in which hip arthroscopy is not a suitable option for treatment because of the resulting fracture pattern, which necessitates open reduction along with internal fixation.

Three-dimensional measurement of the hip joint space from clinical CT for the assessment and prediction of osteoarthritis

BackgroundAdvances in our understanding of osteoarthritis have been hampered by an ongoing inability to detect relevant structural changes in vivo. Radiography, which remains the gold standard for disease assessment, is limited by its two-dimensional representation of the whole joint and the need for observer-generated grading or measurement of disease. The aim of this study was to develop and validate a novel algorithm for three-dimensional (3D) measurement of the hip joint space width (JSW) with clinical CT data. MethodsRight hips were dissected from 20 female cadavers, all with ante-mortem informed consent for participation in post-mortem imaging research. Each hip was imaged with clinical CT (test set) and high resolution peripheral quantitative CT (validation set). An automated model-based deconvolution approach was then applied to measure JSW in 3D from clinical CT data. This study was approved by the Cambridge Human Biology Research Ethics Committee. FindingsEach hip joint was processed with a pipeline of automatic sphere fitting to the femoral head, manual 3D segmentation of joint space limits on the surface of this sphere, and subsequent automatic JSW measurement with a technique called joint space mapping. With a model-based approach, JSW was measured as the distance between opposing subchondral bone edges after deconvolution of the clinical CT data. Measurement validation was performed after cross-registration with the corresponding high resolution data, using a thresholding technique to determine JSW in this data set. Joint space mapping of clinical CT data was both technically accurate and precise over a 95% range of high resolution JSW values, from 1·48 to 4·61 mm (mean bias +0·02 mm [SD 0·43]). InterpretationJoint space mapping is a new image analysis technique that can automatically measure hip joint space in 3D from clinical CT data with high accuracy and precision, subsequently building a 3D model of the joint itself. This technique could deliver a step-change both in research trials and in the clinical setting, where the ability to stratify individuals for therapy and then evaluate disease accordingly is essential for prognostication and monitoring treatment efficacy over time. FundingWellcome Trust.

Unusual MRI Findings in a Polio Survivor.

A 63-year-old male consulted our institution due to worsening of right hip pain for approximately one month. The patient had no apparent functional disorders besides rigidity of the right ankle secondary to childhood poliomyelitis. Plain radiographs demonstrated narrowing of the right hip joint space. Magnetic resonance imaging (MRI) showed unusual findings in the right gluteus medius muscle, suspecting a malignant musculoskeletal tumor. Further examinations clarified acute inflammation caused by Staphylococcus aureus with no atypia. After treatment, serum inflammatory markers normalized and MRI showed homogeneous fat signal intensity in the muscle, which was consistent with poliomyelitis. Total hip arthroplasty was performed due to progression of osteoarthritis. Intraoperative findings showed flaccidity of the gluteus medius muscle, and histological examination of the specimen also was compatible with poliomyelitis. Postoperatively there was no hip instability and the patient has been able to resume his previous physical activity. To our knowledge, this is the first report regarding polio survivors combined with septic arthritis, and sole MRI examination was unable to lead to the diagnosis. The current patient demonstrates the possibility that the involved muscles in poliomyelitis exist even in asymptomatic regions, which will be helpful for accurate diagnosis and life guidance in polio survivors.

Magnetic Resonance Arthrography and the Prevalence of Acetabular Labral Tears in Patients 50 Years of Age and Older: Is It Really Indicated?

Objectives:Arthroscopy for acetabular labral tears has minimal impact on pain and function in patients older than 50 years of age in the setting of concomitant osteoarthritis. Despite this, many physicians continue to seek diagnoses of labral tears in older arthritic patients with magnetic resonance arthrography. The inefficacy of surgical management and the suggested high prevalence of this condition in both symptomatic and asymptomatic patients call into question the utility of diagnosis through an invasive and expensive imaging modality. The purpose of this study is to assess the frequency of acetabular labral tears in patients aged 50 years and older with hip pain and to correlate the likelihood of a labral tear with the severity of osteoarthritis as visualized on conventional radiograph.Methods:From 2004-2013, 208 patients aged 50 years and older who underwent hip MR arthrogram and hip radiographs within a 12-month period were identified. Age, gender, grade and location of labral tear, hip alpha angle, hip Tönnis grade, and hip joint space width were documented for each patient. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on hip radiographs by a musculoskeletal radiologist.Results:On MR arthrography, labral pathology was identified in 93% of patients (73.1% labral tearing, 20.2% labral fraying or degeneration). In patients with moderate to severe osteoarthritis (Tönnis grade 2-3), 100% had labral pathology (73.1% labral tearing, 26.9% labral fraying or degeneration). Similarly, in patients with joint space width ≤ 2mm, 100% had labral pathology (81.2% labral tearing, 18.8% labral fraying or degeneration). There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width.Conclusion:Given the high frequency of tears, as well as the questionable efficacy of arthroscopic surgical intervention in these patients, only good surgical candidates with chronic hip pain and minimal evidence of osteoarthritis (joint space width > 2mm, Tönnis grade 0-1) on initial radiographic evaluation should be considered for magnetic resonance arthrography.

CLINICAL HETEROGENEITY OF EARLY AXIAL SPONDYLOARTHRITIS: ANALYSIS OF CLINICAL AND RADIOLOGICAL FINDINGS IN CRIMEA’S PATIENTS

Ankylosing spondylitis (AS) is characterized by considerable variation in the rate of development of structural changes in the vertebral column and joints. As of now, the clinical and laboratory predictors of progression of undifferentiated axial spondyloarthritis (SpA) to AS have not been adequately explored. Objective: to study the clinical features of early axial SpA in view of radiographic changes in the sacroiliac and hip joints and spinal column. Subject s and methods. The rate of different clinical syndromes of axial SpA was analyzed in 162 patients. The study included less than 35-year-old patients with a 2-to-5-year history of axial SpA that was first diagnosed according to the 2009 ASAS criteria, by excluding psoriatic and reactive arthritis and inflammatory bowel diseaserelated arthritis. Result s and discussion. The examinees were diagnosed with undifferentiated SpA (52.5%), advanced AS (43.2%), and late AS (in the presence of syndesmophytes) (4.3%). 38.3% of patients had peripheral arthritis (PA), 8.6% – dactylitis, 28.4% – enthesitis , and 4.9% – uveitis. The patients with advanced AS had higher C-reactive protein (CRP) levels (38.7 [22.3; 45.8]) and lower rates of PA (27%) than those with undifferentiated axial SpA (14.4 [4.2; 18.6] mg/l and 48%, respectively; p < 0.05). The patients with late AS had more commonly enthesitis (71.4%) and HLA-B27 (100%) than those with undifferentiated axial SpA (31.4 and 78.8%) and those with advanced AS (22.3 and 81.4%, respectively; p < 0.05). Radiographic narrowing of the hip joint space was accompanied by increases in the rate of enthesitis up to 56.2% and HLA-B27 up to 93.7% (the remaining patients exhibited 24.6 and 79.5% increases, respectively (p < 0.05). Conclusion. High CRP levels, presence of enthesitis and HLA-B27 may be regarded as predictors for rapid progression of structural changes in patients with early axial SpA. DOI: http://dx.doi.org/10.14412/1995-4484-2015-139-142

Location-specific hip joint space width for progression of hip osteoarthritis – Data from the Osteoarthritis Initiative

To establish the performance of a location-specific computer-assisted quantitative measure of hip joint space width (JSW), by measuring responsiveness in those with hip osteoarthritis (OA) and pain and those without. Secondary purposes included investigating the most responsive location and comparison to minimum joint space width (mJSW). nested case-control. from the Osteoarthritis Initiative (OAI), a longitudinal cohort study of knee OA. All participants had standardized standing anterior-posterior (AP) pelvis radiographs at baseline and 48 months. Case definition (1): subjects with a total hip replacement (THR) after the 48 month visit (n = 27) were selected and matched (1:1) on sex and age to subjects without a THR. Case definition (2): subjects with a THR at any point after baseline (n = 79) were selected and the contralateral (CL) hip was designated the case hip, and subjects were matched (1:1) as above. Pain: the CL hip group were examined for the presence/absence of pain. Measurements of superior hip JSW were made at three fixed locations relative to a landmark-based line, facilitated by software. The standardized response mean (SRM) was used to examine sensitivity to change from baseline to 48 months. Paired t-tests were used to compare cases and controls. Significant differences were observed between cases and controls and those with and without pain. The location-specific measure outperformed mJSW in all analyses, with SRM ranging from 0.53 (contralateral hip) to 1.06 (THR hip). The superior-medial location was most responsive. A new computer-assisted location-specific measure of hip JSW may provide a superior method to mJSW for radiographic OA progression. The superior-medial location was the most responsive.

Numerical simulation of three-dimensional flow-induced microstructure in a simplified prosthetic hip joint with nematic liquid crystal lubricant

The nature of liquid crystalline materials leads to a preferred direction of molecules in the vicinity of solid surfaces that gives them outstanding tribological properties. Intrinsic molecular order of liquid crystalline materials close to the solid boundaries protects the rubbing surfaces against wear. Due to the bio-compatible nature of most lyotropic liquid crystalline materials, they have been considered as viable candidates to be used as bio-lubricants. In order to understand the complex flow patterns and microstructure of liquid crystals, in this paper, start-up flow-induced microstructure of a nematic liquid crystal in a simplified capsular space of prosthetic hip joint was studied using the Landau-de Gennes nematodynamic theory. Flow streamlines, dimensionless pressure distribution, and rheological properties for a liquid crystal and for synovial fluid affected by rheumatoid arthritis (RA) were presented and compared. The liquid crystals exhibited higher degrees of net pressure lifting force across the capsular gap while forming an ordered molecular layer close to the solid surfaces that protects the surface against wearing mechanism while decreasing the coefficient of friction (COF). Formation of molecular microstructure in vicinity of solid surfaces with perpendicular orientation to the normal surface vector was observed.

Location-specific hip joint space width for progression of hip osteoarthritis: predictive validity and responsiveness of a new computerized measure

Location-specific hip joint space width for progression of hip osteoarthritis: predictive validity and responsiveness of a new computerized measure

Evaluation of a method for the assessment of anterior acetabular coverage and hip joint space width

The false-profile view (FP) is an oblique view of the acetabulum and a true lateral view of femur and joint. It evaluates anterior and posterior hip joint space width (JSW) and anterior acetabular coverage using the vertical-center margin angle (VCA). The biplanar slot scanner (SS) allows simultaneous bilateral acquisitions of oblique views of hip joints. The aim of this work was to compare SS versus FP for the evaluation of VCA and JSW and to test its reproducibility and validity. A prospective study of 28 patients (55 hips) with hip pain was performed from November 2011 until May 2012. Two readers measured VCA and JSW. JSW was normalized by the diameter of the femoral head for each technique. The radiation exposure was recorded and compared between the two modalities. Student's t test and the Pearson's correlation assessed the agreement between SS and FP. The intraclass correlation coefficient (ICC) was used to assess the interobserver agreement. The mean VCA angle was 32.1° (± 7.1°) and 30.3° (± 8.5°) with FP and SS, respectively. The coefficient of correlation was 0.90 (p < 0.01). The coefficient of correlation of normalized JSW was 0.83, 0.85, and 0.87 at anterior, vertical, and posterior points, respectively). The ICC was between 0.69 and 0.81 for each modality. The mean radiation exposure was 1.33 (± 0.02) mGy versus 8.69 (±0.04) mGy for FP and SS, respectively (p < 0.0001). SS has the potential advantages of simultaneous bilateral acquisition, higher standardization, and is less irradiating. SS is reliable for coxometry.

Analysis of X-ray and MRI characteristic of hip-joint lesion in 64 patients with ankylosing spondylitis

Objective To explore the X-ray and MRI manifestations of hip joint lesion in ankylosing spondylitis patients and give useful reference for diagnosis,assess of disease activity and therapeutic response and prognosis.Methods The X-ray manifestation and MRI manifestation of 64 cases of patients with ankylosing spondylitis were analyzed.Results In X-ray analyzed acetabulum joint changes 42,hip joint hyperostosis 47,hip joint interval narrow 13,hip joint osteoporosis 11,MRI analyzed synovial inflammatory change 64,subcartilaginous bone marrow edema 48,joint cartilage lesion and joint surface saccular change 42,tendon and ligament of enthesopathy 24,joint space change 13.Conclusion In patients with ankylosing spondylitis,X-ray manifestation of hip-joint lesion commonly included leacetabulum joint changes,hip joint hyperostosis and hip joint space narrowing while MRI manifestation included inflammation of synovium,edema of subcartilaginous bone marrow,and tendon of enthesopathy which suggested high disease activity.To suspicious hip-joint lesion in patients with ankylosing spondylitis,magnetic resonance imaging should be taken for judgment of disease activity and determine of treatment plan. Key words: Hip joint; Spondylitis, ankylosing; Radiography; Magnetic resonance imaging

Long-term results of the augmented PFNA: a prospective multicenter trial

Pertrochanteric fractures are increasing and their operative treatment remains under discussion. Failures needing reoperations such as a cut-out are reported to be high and are associated with multiple factors including poor bone quality, poor fracture reduction and improper implant placement. The PFNA(®) with perforated blade offers an option for standardized cement augmentation with a PMMA cement to provide more stability to the fracture fixation. It remains unclear if the augmentation of this implant does any harm in a longer time span. This prospective multicenter study shows clinical and radiological results with this implant with a mean follow-up time of 15 months. In 5 European clinics, 62 patients (79 % female, mean age 85.3 years) suffering from an osteoporotic pertrochanteric fracture (AO 31) were treated with the augmented PFNA(®). The primary objectives were assessment of activities of daily living, pain and mobility. Furthermore, the X-rays were analyzed for the cortical thickness index, changes of the trabecular structure around the cement and the hip joint space. The mean follow-up time was 15.3 months. We observed callus healing in all cases. The surgical complication rate was 3.2 % with no complication related to the cement augmentation. A mean volume of 3.8 ml of cement was injected and no complication was reported due to this procedure. 59.9 % reached their prefracture mobility level until follow-up. The mean hip joint space did not change significantly until follow-up and there were no signs of osteonecrosis in the follow-up X-rays. Furthermore, no blade migration was assessed. This study makes us believe that the standardized augmentation of the PFNA with a perforated blade is a safe method to treat pertrochanteric femoral fractures. It leads to good functional results and is not associated with cartilage or bone necrosis.

고관절의 자기공명관절조영검사 시 가돌리늄 함유량이 높은 조영제의 유용성

The purpose of this study is to maximize diagnositc usefulness with increasing signal to noise ratio(SNR) and contrast to noise ratio(CNR) by using a 1mmol/mL gadolinium contrast agent. From January 2012 to June 2013 fourty-seven patients were underwent the MRI scanning to investigate the contrast difference in gadolinium content. Twenty of the patients were injencted the commercial contrast agent containing 0.5mmol/mL gadolinium and the rest of them were injected the new contrast agent containing 1mmol/mL gadolinium called gadobutrol. We measured and evaluated each SNR and CNR of the hip joint space, iliopsoas muscle and femoral head. As a result, using the 1mmol/mL gadolinium contrast agent had the higher SNR results than using the 0.5mmol/mL agent(27% in the hip joint, 30.01% in the femoral head). Also CNR using the 1mmol/mL gadolinium agent was proved to be higher than that of using 0.5mmol/mL agent(28.31% in the ilopsoas muscle and 26.74% in the femoral head). Therefore, the contrast agent containing more gadolinium like 1mmol/mL used in this study is more effective to shorten T1 relaxation time, so it increases the signal intensity and CNR and furthermore maximizes diagnostic value. This study reports the usefulness of the 1mmol/mL contrast agent in the contrast-enhanced magnetic resonance hip arthrography for the first. Therefore, it can be considered to have an meaningful academic value as showing the method for increasing the diagnostic usefulness by using the 1mmol/mL contrast agent.

Assessing leg length after fixation of comminuted femur fractures.

Nailing comminuted femur fractures may result in leg shortening, producing significant complications including pelvic tilt, narrowing of the hip joint space, mechanical and functional changes in gait, an increase in energy expenditures, and strains on spinal ligaments, leading to spinal deformities. The frequency of this complication in patients managed with an intramedullary (IM) nail for comminuted diaphyseal fractures is unknown. We therefore determined (1) the frequency of LLDs, (2) whether a specific fracture pattern was associated with LLDs, (3) the frequency of reoperation, and (4) whether revision fixation ultimately corrected the LLD. We studied 83 patients with 91 AO/OTA Type B or Type C fractures fixed with either an antegrade or retrograde IM nail from July 2002 through December 2005. There were 60 males and 23 females, with a mean age of 30 years (range, 15-79 years). All underwent a digitized CT scan in the immediate postoperative period. Measurements of both legs were performed. Any fixation producing a discrepancy and requiring a return to surgery was identified. An mean LLD of 0.58 cm was found in 98% of the patients, but only six (7%) patients had an LLD of greater than 1.25 cm. No fracture pattern or the presentation of bilateral injuries demonstrated a greater incidence of LLD. Of the patients with LLD, two patients refused further surgery while the remaining four patients, two Type B and two Type C fractures, ultimately underwent revision fixation. Repeat CT scans after revision surgery of all four patients demonstrated a residual LLD of only 0.2 cm. Postoperative CT scans appear to be an efficient method to measure femoral length after IM nailing. Although residual LLDs may be common in comminuted femurs treated with IM nails, most LLDs do not appear to be functionally relevant. When an LLD of greater than 1.5 cm is identified, it should be discussed with the patient, who should be told that potential complications may occur with larger LLDs and that sometimes patients may benefit from repeat surgery. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

OP0035 Value of bilateral standing oblique radiographs (“FAUX profil de lequesne“) in the diagnosis of hip osteoarthritis

BackgroundMeasurement of joint space width (JSW) on antero-posterior (AP) radiograph of the pelvis is the reference imaging method for the diagnosis and follow-up of hip osteoarthritis (OA). However, the AP...

THU0279 Absence of radiographic progression of hip arthritis in patients with ankylosing spondylitis treated with infliximab for 6 years

BackgroundHip involvement is the most frequent extraspinal arthritic manifestation of Ankylosing Spondylitis (AS) and a common cause of disability. In contrast to the classical changes in the spine, hip joint...

Absence of radiographic progression of hip arthritis during infliximab treatment for ankylosing spondylitis

This study aims to examine the impact of long-term treatment with the anti-TNF antibody infliximab on radiographic progression of hip arthritis in ankylosing spondylitis. Anteroposterior X-rays of the pelvis obtained at baseline from consecutive patients with ankylosing spondylitis and bilateral hip arthritis were compared with X-rays obtained after 6 ± 2.5 years (mean ± SD) of continuous infliximab treatment. Analysis was performed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) scoring system (min 0, max 4). Hip joint space width was also assessed by the average of measurements at three distinct sites between the acetabulum and femoral head. In 23 patients with active disease (21 men, mean age and disease duration of 45 and 16 years, respectively), the BASRI-h score at baseline was 1 in 7, 2 in 16, 3 in 16, and 4 in 7 hips (including two arthroplasties). Individual BASRI-h scores at baseline (2.50 ± 0.86, mean ± SD) remained unchanged in all patients at end of follow-up. At baseline, the average width of the whole joint space (3.56 ± 0.70 mm, n = 44) was not associated with disease activity measurements but negatively correlated with BAS functional index (Spearman r = -0.5, P = 0.007). After 2-10 years of infliximab treatment, the average width of the whole joint space in these patients (3.59 ± 0.79 mm) was not reduced. These results suggest that radiographic progression of hip arthritis in ankylosing spondylitis may be arrested during infliximab treatment.

Comparison of radiographic hip joint space in weight bearing and supine X-rays in patients with hip pathology

Comparison of radiographic hip joint space in weight bearing and supine X-rays in patients with hip pathology

Hip joint space and disability

Hip joint space and disability

Decompression Illness with Extensive Gas Bubble Formation

A 32-year-old man presented with unconsciousness after diving. He had surfaced from a 50-meter depth of water within 10 minutes and his consciousness later became disturbed. On arrival, an examination revealed the cutaneous finding of livedo reticularis (Picture 1) and hyperhemoglobinemia (Hb: 21.8 g/dL). An endotracheal tube was inserted and whole-body computed tomography performed to examine possible injuries revealed generalized extensive gas bubble formation in the brain parenchyma, the right subclavian, portal and bilateral femoral veins and the hip joint spaces (Picture 2, arrows). Despite supplying 100% oxygen and arranging for hyperbaric oxygen therapy, the patient died before the start of the hyperbaric oxygen therapy. Type II (severe form) decompression illness is character-

Accuracy Limits for the Thickness Measurement of the Hip Joint Cartilage in 3-D MR Images: Simulation and Validation

This paper describes a theoretical simulation method for ascertaining the inherent limits on the accuracy of thickness measurement of hip joint cartilage in 3-D MR images. This method can specify where and how thickness can be measured with sufficient accuracy under the certain MR imaging conditions. In the numerical simulation, we present a mathematical model for two adjacent sheet structures separated by a small distance, which simulated the femoral and acetabular cartilage and the joint space width in the hip joint; moreover, we perform the numerical simulation of MR imaging and postprocessing for thickness measurement. We especially focused on the effects of voxel anisotropy in MR imaging with variable orientation of cartilage surface and different joint space width. Also, thickness measurement is performed in MR imaging with isotropic voxel. The results from MR data with isotropic voxels show that accurate measurement of cartilage thickness at location of measured values of the hip joint space width and the cartilage thickness being two times as large as the voxel size or above should be possible. The simulation method is validated by comparison with the actual results obtained from the experiments using three phantoms, five normal cadaver hip specimens, and nine patients with osteoarthritis.