Hip Magnetic Resonance Imaging Research Articles

Ligamentum teres lesions are associated with compositional and structural hip cartilage degenerative change: region-specific cartilage degeneration.

To investigate the association between magnetic resonance imaging (MRI)-based ligamentum teres lesions (LTL) and structural hip degeneration. Bilateral 3-T hip MRIs of participants (n = 93 [36 men]; mean age ( ± SD) 51 years ± 15.4) recruited from the community and the orthopedic clinic of a single medical center were included. Clinical and imaging data acquired included hip disability and osteoarthritis outcome scores, semi-quantitative scoring of hip osteoarthritis on MRI (SHOMRI) scores on fluid-sensitive sequences, and cartilage T1ρ/T2 compositional sequences. An MRI-based LTL scoring system, incorporating continuity, thickening, and signal intensity, ranging from 0 (normal) to 4 (complete tear) was constructed. Hip morphological features associated with LTL, based on functional or anatomical relationships to LT, were defined. Relationships between MRI-LT scores and SHOMRI, global/regional cartilage T1ρ/T2, and proposed morphological abnormalities and LTL were explored by mixed effects linear and logistic regression models. In 82 (46.1%) hips, no pain was documented; 118 (63.4%) and 68 (36.6%) hips were graded as KL-grade ≤ 1 and ≥ 2, respectively. Compared to MRI-LT score = 0 (normal), score = 4 (complete tear) revealed significantly worse subchondral bony degenerative changes for bone marrow lesions (SHOMRI-BML) and subchondral cysts (SHOMRI-sc) (p < 0.001, p = 0.015, respectively). Global acetabular T1ρ, femoral T2 were significantly increased for abnormal MRI-LT scores (p-range = 0.005-0.032). Regional analyses revealed significantly increased T1ρ/T2 in central acetabular/increased T2 in off-central femoral regions (p-range = 0.005-0.046). Pulvinar effusion-synovitis, shallow fovea, and foveal osteophytes were significantly associated with abnormal LT MRI findings (p-range = < 0.001-0.044). MRI abnormalities of LT are associated with worse SHOMRI-sc/BML scores, indicative of hip osteoarthritis and higher T1ρ and T2 that differ by region. Pulvinar effusion-synovitis and changes in femoral head morphology are associated with LTL. Abnormal ligamentum teres findings identified via MRI are associated with structural degenerative changes of the hip joint and alterations in acetabular and femoral cartilage compositions show spatial differences in relation to LTL. The clinical significance of common ligamentum teres lesions (LTL) on MRI is not well understood. LTL identified by an MRI-based scoring system is associated with worse biomarkers, indicating more advanced degenerative hip changes. Effusion-synovitis signal at pulvinar, shallow fovea capitis, and foveal osteophytes are associated with LTL on imaging.

Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis: a PETALE cohort study.

Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. Survivors (n = 97, 24.2 ± 6.7years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8%male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39-0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.

Automated evaluation of hip abductor muscle quality and size in hip osteoarthritis: Localized muscle regions are strongly associated with overall muscle quality

Limited information exists regarding abductor muscle quality variation across its length and which locations are most representative of overall muscle quality. This is exacerbated by time-intensive processes for manual muscle segmentation, which limits feasibility of large cohort analyses. The purpose of this study was to develop an automated and localized analysis pipeline that accurately estimates hip abductor muscle quality and size in individuals with mild-to-moderate hip osteoarthritis (OA) and identifies regions of each muscle which provide best estimates of overall muscle quality.Forty-four participants (age 52.7 ± 16.1 years, BMI 23.7 ± 3.4 kg/m2, 14 males) with and without mild-to-moderate radiographic hip OA were recruited for this study. Unilateral hip magnetic resonance (MR) images were acquired on a 3.0 T MR scanner and included axial T1-weighted fast spin echo and 3D axial Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation (IDEAL-IQ) spoiled gradient-recalled echo (SPGR) with multi-peak fat spectrum modeling and single T2* correction. A three dimensional (3D) V-Net convolutional neural network was trained to automatically segment the gluteus medius (GMED), gluteus minimus (GMIN), and tensor fascia lata (TFL) on axial IDEAL-IQ. Agreement between manual and automatic segmentation and associations between axial fat fraction (FF) estimated from IDEAL-IQ and overall muscle FF were evaluated.Dice scores for automatic segmentation were 0.94, 0.87, and 0.91 for GMED, GMIN, and TFL, respectively. GMED, GMIN, and TFL volumetric and FF measures were strongly correlated (r: 0.92–0.99) between automatic and manual segmentations, where all values fell within the 95% limits of agreement of [−9.79 cm3, 17.43 cm3] and [−1.99%, 2.89%], respectively. Axial FF was significantly associated with overall FF with the strongest correlations at 50%, 50%, and 65% the length of the GMED, GMIN, and TFL muscles, respectively (r: 0.93–0.97). An automated and localized analysis can provide efficient and accurate estimates of hip abductor muscle quality and size across muscle length. Specific regions of the muscle may be used to estimate overall muscle quality in an abbreviated evaluation of muscle quality.

Unnecessary interventions for the management of hip osteoarthritis: a population-based cohort study.

Patients aged 40-60 years who require total hip arthroplasty (THA) often first receive unindicated hip arthroscopy or magnetic resonance imaging (MRI). Our objective was to identify potentially inappropriate resource utilization before THA, specifically reporting on the proportion of patients aged 40-60 years who underwent hip arthroscopy or MRI in the year before THA. We conducted a retrospective, population-based study at the provincial level. We retrieved data from the Canadian Institute for Health Information (CIHI). We included all Ontario residents who underwent an elective, primary THA for osteoarthritis between Apr. 1, 2004, and Mar. 31, 2016. We identified the rates and timing of patients who underwent an MRI or hip arthroscopy before their index THA. The percentage of patients who underwent an MRI before THA increased significantly over the study period, from 8.7% in 2004 to 23.8% in 2015. There was also a significant but variable trend in the percentage of patients who underwent a hip arthroscopy before THA. Our results demonstrate a high, gradually increasing proportion of patients who received a hip MRI and a low but increasing proportion of patients who received hip arthroscopy in close proximity to THA. Multidisciplinary collaboration may improve knowledge translation and help reduce the rate of clinically unnecessary diagnostic and therapeutic interventions in this population of patients who require THA.

Hip MRI in flexion abduction external rotation for assessment of the ischiofemoral interval in patients with hip pain—a feasibility study

ObjectivesTo assess the feasibility of flexion-abduction-external rotation (FABER) magnetic resonance imaging (MRI) of the hip to visualize changes in the ischiofemoral interval and ability to provoke foveal excursion over the acetabular rim.MethodsIRB-approved retrospective single-center study. Patients underwent non-contrast 1.5-T hip MRI in the neutral and FABER position. Two readers measured the ischiofemoral interval at three levels: proximal/distal intertrochanteric distance and ischiofemoral space. Subgroup analysis was performed for hips with/without high femoral torsion, or quadratus femoris muscle edema (QFME), respectively. A receiver operating curve with calculation of the area under the curve (AUC) for the prediction of QFME was calculated. The presence of foveal excursion in both positions was assessed.ResultsOne hundred ten patients (121 hips, mean age 34 ± 11 years, 67 females) were evaluated. FABER-MRI led to narrowing (both p < .001) of the ischiofemoral interval which decreased more at the proximal (mean decrease by 26 ± 7 mm) than at the distal (6 ± 7 mm) intertrochanteric ridge. With high femoral torsion/ QFME, the ischiofemoral interval was significantly narrower at all three measurement locations compared to normal torsion/no QFME (p < .05). Accuracy for predicting QFME was high with an AUC of .89 (95% CI .82–.94) using a threshold of ≤ 7 mm for the proximal intertrochanteric distance.With FABER-MRI foveal excursion was more frequent in hips with QFME (63% vs 25%; p = .021).ConclusionHip MRI in the FABER position is feasible, visualizes narrowing of the ischiofemoral interval, and can provoke foveal excursion.Critical relevance statementFABER MRI may be helpful in diagnosing ischiofemoral impingement and detecting concomitant hip instability by overcoming shortcomings of static MR protocols that do not allow visualization of dynamic changes in the ischiofemoral interval and thus may improve surgical decision making.Key points• FABER MRI enables visualization of narrowing of the ischiofemoral interval proximal to the lesser trochanter.• Proximal intertrochanteric distance of ≤ 7 mm accurately predicts quadratus femoris muscle edema.• Foveal excursion was more frequent in hips with quadratus femoris muscle edema.Graphical

Radial Planes in Hip Magnetic Resonance Imaging: Techniques, Applications, and Perspectives.

The hip cartilage and labrum, as the main targets of femoroacetabular impingement, sports-related or traumatic damage, as well as congenital and developmental abnormalities, have attracted increasing attention with the development of magnetic resonance imaging (MRI) and hip arthroscopy. MRI is a commonly used imaging modality to noninvasively visualize the hip cartilage and labral lesions. However, conventional orthogonal MRI planes encounter unique challenges given the ball-and-socket configuration of the hip joint, its anatomically abducted and anteverted orientation, and the thin, closely apposed cartilage enveloping the femoral head and acetabulum. Advancements in hip MRI's radial plane, which is acquired through the center of the hip joint, offer a solution. This technology provides true cross-sectional images of the cartilage and labrum perpendicular to the curvature of the joint, thereby mitigating the partial-volume-averaging effects. The integration of 3.0-Tesla high field strength and three-dimensional (3D) acquisition techniques further enhances the capabilities of the radial plane. This combination yields a high signal-to-noise ratio, high spatial resolution, high contrast between intraarticular structures, while minimizing partial-volume-averaging effects. Such improvements potentially facilitate the comprehensive detection of even minor chondral and labral lesions. The capability for multiplanar reconstruction from a single 3D volumetric acquisition further strengthens the usefulness of the radial plane by aiding in precise localization of hip cartilage and labral lesions, in line with hip arthroscopy findings. These advancements have the potential to standardize MRI evaluations and radiographic reporting systems for hip cartilage and labrum, offering precise guidance for hip arthroscopy. This article presents a comprehensive review of radial plane technology applied to the hip MRI, and discusses the morphological assessment and localization of hip cartilage and labral lesions utilizing this advanced imaging technique. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.

Arthroscopic treatment of deep gluteal syndrome and the application value of high-frequency ultrasound

PurposeThis study aimed to evaluate the efficacy of arthroscopic sciatic neurolysis for treating deep gluteal syndrome (DGS) and to analyse the application value of high-frequency ultrasound during perioperative period.MethodsBetween June 2020 and February 2022, 30 patients with DGS who underwent failed conservative treatment were retrospectively analysed. Lateral arthroscopic exploration of the deep gluteal space and sciatic neurolysis were performed. In addition to pelvic X-ray, lumbar disc and hip magnetic resonance imaging (MRI), ultrasonography of the sciatic nerve was also performed in all patients. The visual analogue scale pain score (VAS), modified Harris hip score (mHHS) and Benson symptom-rating scale were used to evaluate the clinical efficacy. The correlation between preoperative sciatic nerve ultrasound and arthroscopic findings was analysed.ResultsThe median follow-up for these patients was 13 months (range,12–21 months). Preoperative ultrasonography showed precise morphological changes in 26 sciatic nerves of patients. The VAS score decreased from 5.0 (4.0, 6.0) preoperatively to 0.5 (0, 1.0) postoperatively (p < 0.001), and the mHHS increased from 64.0 (57.0, 67.0) preoperatively to 95.0 (93.0, 97.0) postoperatively (p < 0.001). The Benson symptom score was excellent in 15 cases, good in 12 cases, fair in 2 cases, poor in 1 case; thus, the score was excellent or good in 90% of the cases. Preoperative ultrasound diagnosis and intra-operative findings matched up in all cases. There were four cases of transient numbness in the posterior thigh.ConclusionsArthroscopic sciatic neurolysis is a safe and effective treatment option for DGS patients who fail conservative treatment. Ultrasound diagnosis matched the arthroscopic findings perfectly. Preoperative Doppler ultrasound can assist surgical decision-making, guide intraoperative release.

Multifid Iliopsoas Tendons Are More Common in Patients With Painful Snapping Iliopsoas Tendons

To retrospectively determine the prevalence of multifid tendons in a population of patients who underwent iliopsoas release for painful snapping iliopsoas tendons. Patients who underwent iliopsoas release for painful snapping iliopsoas tendons were retrospectively identified from a database of patients who had undergone arthroscopic hip surgery performed by a single surgeon between 2011 and 2020. Patients who had incomplete data or who underwent prior fracture fixation, joint arthroplasty, pelvic surgery, or other interventions for snapping hip were excluded. Magnetic resonance imaging (MRI) and operative reports were reviewed and compared with those of an age-matched control group of patients who had undergone hip or pelvic MRI examinations in the past year for different indications. This study included 91 patients (78 female and 13 male patients; mean age, 23.3 years) who were treated operatively for painful snapping hip and 78 controls (54 female and 24 male patients; mean age, 28.4 years) who received hip or pelvic MRI for other indications. Among the patients who underwent iliopsoas release, there were 5 unifid iliopsoas tendons (5.5%) compared with 86 multifid iliopsoas tendons (94.5%) when classified with MRI whereas operative examination showed 19 unifid tendons (20.9%) compared with 72 multifid tendons (79.1%, P < .001). When the MRI scans of the operative group were compared with the MRI scans of the control group, the patients who underwent surgery for painful snapping hip had a higher rate of multifid tendons (94.5% of operative hips compared with 69.2% of control right hips [P< .001] and 74.4% of control left hips [P < .001]). However, when the operative reports were used to classify the iliopsoas tendon, there was no significance between the operative and control groups (79.1% of operative hips had multifid tendons compared with 69.2% of control right hips [P= .141] and 74.4% of control left hips [P= .464]). For patients with symptomatic snapping hip undergoing iliopsoas lengthening, multifid iliopsoas tendons are more prevalent than in a control population. Level IV, prognostic case series.

Reliability of Conventional Hip MRI in Detecting Labral Tear and Labrocartilagenous Lesions in cases of Femoroacetabular Impingement, A Comparative Study with Hip Arthroscopy.

Imaging studies play a crucial role in diagnosing femoroacetabular impingement (FAI), including plain radiography and Magnetic Resonance Imaging (MRI). FAI is a combined pathology of bony abnormality, labral and labrocartilagenous erosions. Surgical treatment for such cases has become more established and preoperative imaging is the roadmap that includes the assessment of labrum and articular cartilage. During a period of 2 years, thirty-seven patients with a clinical diagnosis of FAI were retrospectively enrolled in this study, including 17 men and 20 women, aged 27-62 years. There were 22 right hips and 15 left hips. MRI was done for all patients to identify bony details, labral and chondral abnormalities and to exclude coexisting disorders. The imaging findings were compared with the arthroscopic data. 15 patients had Pincer FAI, 11 patients had CAM, and 11 patients had combined Cam/Pincer FAI. Labral tear was detected in 100 % of patients, 97 % had an anterosuperior labral tear. 82 % of patients had partial thickness cartilage lesions and 8 % had full thickness cartilage lesions. MRI had a sensitivity of 100 % compared to hip arthroscopy in detecting labral tear, 60 % in detecting cartilage erosion. Conventional hip MRI detects bony changes in FAI, type of impingement and associated labral tear and cartilage erosions in comparison to the hip arthroscopy.

Asymptomatic Gluteal Tendinosis Does Not Adversely Affect Outcomes of Primary Total Hip Arthroplasty

BackgroundThe aim of this study was to compare outcomes after total hip arthroplasty (THA) in patients who have preoperative asymptomatic gluteal tendinosis (aGT) to a control group with no gluteal tendinosis (GT). MethodsA retrospective analysis was performed using data from patients who underwent THA between March 2016 and October 2020. An aGT was diagnosed using hip magnetic resonance imaging (MRI) without clinical symptoms. Patients who had aGT were matched (1:1) to patients without GT on MRI. A total of 56 aGT hips and 56 hips without GT were found using propensity-score matching. Patient-reported outcomes, intraoperative macroscopic evaluation, outcome measurements, postoperative physical examinations, complications, and revisions were compared for both groups. ResultsWhen compared to preoperative outcomes, both groups demonstrated significant improvements in patients-reported outcomes at the final follow-up. There were no significant differences between both groups for preoperative scores, 2-year postoperative outcome scores, or the magnitude of improvement. Patients in the aGT group were significantly less likely to obtain the MCID for the SF-36 MCS score (50.2 versus 69.3%, P = .034). However, there were no other differences in the rates of meeting the MCID between both groups. The aGT group demonstrated significantly higher rates of partial tendon degeneration of the gluteus medius muscle. ConclusionAsymptomatic gluteal tendinosis patients who have osteoarthritis and undergo THA may expect favorable patients-reported outcomes at minimum 2-year follow-up. These results were comparable with those of a control group of patients without gluteal tendinosis. Level of evidenceIII.

The prevalence and associated factors of myocardial involvement in Duchenne muscular dystrophy patients in the first decade of life.

The prevalence and associated factors of myocardial involvement in Duchenne muscular dystrophy patients in the first decade of life.

Deep-learning based quantification model for hip bone marrow edema and synovitis in patients with spondyloarthritis based on magnetic resonance images.

Objectives: Hip inflammation is one of the most common complications in patients with spondyloarthritis (SpA). Herein, we employed use of a deep learning-based magnetic resonance imaging (MRI) evaluation model to identify irregular and multiple inflammatory lesions of the hip. Methods: All of the SpA patients were enrolled at the Xijing Hospital. The erythrocyte sediment rate (ESR), C-reactive protein (CRP), hip function Harris score, and disease activity were evaluated by clinicians. Manual MRI annotations including bone marrow edema (BME) and effusion/synovitis, and a hip MRI scoring system (HIMRISS) assessment was performed by experienced musculoskeletal radiologists. The segmentation accuracies of four deep learning models, including U-Net, UNet++, Attention-Unet, and HRNet, were compared using five-fold cross-validation. The clinical agreement of U-Net was evaluated with clinical symptoms and HIMRISS results. Results: A total of 1945 MRI slices of STIR/T2WI sequences were obtained from 195 SpA patients with hip involvement. After the five-fold cross-validation, U-Net achieved an average segmentation accuracy of 88.48% for the femoral head and 69.36% for inflammatory lesions, which are higher than those obtained by the other three models. The UNet-score, which was calculated based on the same MRI slices as HIMRISS, was significantly correlated with the HIMRISS scores and disease activity indexes (p values <0.05). Conclusion: This deep-learning based automatic MRI evaluation model could achieve similar quantification performance as an expert radiologist, and it has the potential to improve the accuracy and efficiency of clinical diagnosis for SpA patients with hip involvement.

Assessment of femoral retroversion on preoperative hip magnetic resonance imaging in patients with slipped capital femoral epiphysis: Theoretical implications for hip impingement risk estimation.

Slipped capital femoral epiphysis is a common pediatric hip disease and was associated with femoral retroversion, but femoral version was rarely measured. Therefore, mean femoral version, mean femoral neck version, and prevalence of femoral retroversion were analyzed for slipped capital femoral epiphysis patients. A retrospective observational study evaluating preoperative hip magnetic resonance imaging of 27 patients (49 hips) was performed. Twenty-seven untreated slipped capital femoral epiphysis patients (28 slipped capital femoral epiphysis hips and 21 contralateral hips, age 10-16 years) were evaluated (79% stable slipped capital femoral epiphysis, 22 patients; 43% severe slipped capital femoral epiphysis, 12 patients). Femoral version was measured using Murphy method on magnetic resonance imaging (January 2014-December 2021, rapid bilateral 3-dimensional T1 water-only Dixon-based images of pelvis and knee). All slipped capital femoral epiphysis patients underwent surgery after magnetic resonance imaging. Mean femoral version of slipped capital femoral epiphysis patients (-1° ± 15°) was significantly (p < 0.001) lower compared to contralateral side (15° ± 14°). Femoral version of slipped capital femoral epiphysis patients had significantly (p < 0.001) wider range from -42° to 35° (range 77°) compared to contralateral side (-5° to 44°, range 49°). Mean femoral neck version of slipped capital femoral epiphysis patients (6° ± 15°) was lower compared to contralateral side (11° ± 12°). Fifteen slipped capital femoral epiphysis patients (54%) had absolute femoral retroversion (femoral version < 0°). Six of the 12 hips (50%) with severe slips and 4 of the 8 hips (50%) with mild slips had absolute femoral retroversion (femoral version < 0°). Ten slipped capital femoral epiphysis patients (40%) had absolute femoral neck retroversion (femoral neck version < 0°). Although slipped capital femoral epiphysis patients showed asymmetrically lower femoral version compared to contralateral side, there was a wide range of femoral version, underlining the importance of patient-specific femoral version analysis on preoperative magnetic resonance imaging. Absolute femoral retroversion was prevalent in half of slipped capital femoral epiphysis patients, in half of severe slipped capital femoral epiphysis patients, and in half of mild slipped capital femoral epiphysis patients. This has implications for anterior hip impingement and for surgical treatment with in situ pinning or femoral osteotomy (e.g. proximal femoral derotation osteotomy) or other hip preservation surgery.

Patients With Unhealed or Partially Healed Anterior Capsules After Hip Arthroscopy for Borderline Developmental Dysplasia of the Hips Have Inferior Patient-Reported Outcome Measures

To evaluate the changes in anterior hip capsular thickness on pre- and postoperative magnetic resonance imaging (MRI) and their associated clinical outcomes in patients with borderline developmental dysplasia of the hip (BDDH). A minimum 2-year follow-up retrospective analysis was performed using data from symptomatic patients with BDDH who underwent hip arthroscopy with routine capsular closure between 2018 and 2020. An available postoperative hip MRI was a prerequisite for study inclusion. Capsular thickness at the capsulotomy zone was measured on MRI. An analysis of the correlations between anterior capsular thickness differences and demographic factors (including age, sex, body mass index, laterality, preoperative alpha angle and lateral center-edge angle, cartilage lesion grade, follow-up time, and capsule management) was performed. Patients with unhealed or partially healed capsules (study group) were propensity-score matched 1:1 to patients with completely healed capsules based on age, sex, body mass index, and follow-up time. Comparisons and analyses of the following parameters were completed for both groups: patient-reported outcomes (Hip Outcome Score-Activities of Daily Living [HOS-ADL], Hip Outcome Score-Sports-Specific Subscale [HOS-SSS], International Hip Outcome Tool 12-component form [iHOT-12], and modified Harris Hip Score), visual analog scale scores, radiographic measures, performed procedures, and complications. Data were compiled for 59 patients' hips after patient selection. The majority of the repaired hip capsules remained closed (93.2%) at a minimum 2-year follow-up. Propensity-score matching was applied to distribute 25 subjects in the study group and 25 in the control group. The anterior capsule was significantly thinner postoperation in the study group (3.0 ± 1.2 mm vs 4.1 ± 0.6 mm; P < .001). Compared with the control group, patients in the study group had significantly inferior postoperative HOS-ADL (75.1 vs 83.5, P= .007), HOS-SSS (64.5 vs 77.1, P= .005), and iHOT-12 scores (56.1 vs 70.2, P= .006). In addition, patients in the study group were significantly less likely to achieve the minimum clinically important difference for the HOS-ADL score (52% vs 80%, P= .037) score and patient acceptable symptomatic state for the HOS-ADL score (32% vs 60%, P= .047). The majority of the repaired hip capsules in patients with BDDH remained closed but not all capsules completely healed at a minimum 2-year follow-up. Patients with an unhealed or partially healed capsule had inferior HOS-ADL, HOS-SSS, and iHOT-12 scores and were less likely to achieve the minimum clinically important difference and patient acceptable symptomatic state for the HOS-ADL score. III, retrospective comparative prognostic study.

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis.

Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources. To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS. Cohort study; Level of evidence, 3. Included were 1391 patients (mean age, 25.8 years; 63% female; mean body mass index, 25.6) who underwent hip arthroscopy between August 2015 and December 2021 by 1 of 4 fellowship-trained hip surgeons from 4 referral centers. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of nonoperative management, and concomitant periacetabular osteotomy. Patients were stratified into those who were evaluated with preoperative MRI versus those without MRI. Those without MRI received an MRI before surgery without deviation from the established surgical plan. All preoperative MRI scans were compared with the office evaluation and intraoperative findings to assess agreement. Time from office to arthroscopy and/or MRI was recorded. MRI costs were calculated. Of the study patients, 322 were not evaluated with MRI and 1069 were. MRI did not alter surgical or interoperative plans. Both groups had MRI findings demonstrating anterosuperior labral tears treated intraoperatively (99.8% repair, 0.2% debridement, and 0% reconstruction). Compared with patients who were evaluated with MRI and waited 63.0 ± 34.6 days, patients who were not evaluated with MRI underwent surgery 6.5 ± 18.7 days after preoperative MRI. MRI delayed surgery by 24.0 ± 5.3 days and cost a mean $2262 per patient. Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged ≤40 years with a history, physical examination findings, and radiographs concordant with FAIS. Rather, MRI delayed surgery and wasted resources. Routine hip MRI acquisition for the younger population with primary FAIS with a typical presentation should be challenged.

Analysis of therapeutic effect of high focused extracorporeal shock wave comprehensive therapy on femoral head bone marrow edema syndrome

Purpose: This study explored the clinical therapeutic effect of high-focused extracorporeal shock wave therapy (HF-ESWT) combined with exercise rehabilitation and drug therapy on femoral head bone marrow edema syndrome (BMES). Materials and Methods: This study systematically reviewed and analyzed the clinical data of 43 patients with femoral head bone marrow edema who were treated in our hospital from January 2017 to June 2022. Twenty-three patients received HF-ESWT comprehensive treatment. Twenty patients received general treatment including medication and exercise rehabilitation treatment. The treatment methods for Group B patients were the same as Group A, except for not receiving shock wave therapy. Changes in visual analog scale (VAS), Harris score of the hip, and the edema area of region of interest area (ROIA) on hip magnetic resonance imaging (MRI) were analyzed before and after treatment. Results: Our research found that patients receiving HF-ESWT had significantly reduced VAS compared with general treatment at 1, 2, and 3 months (P &lt; 0.05). We found that HF-ESWT comprehensive treatment had significantly improved hip Harris score compared with general treatment at 2 and 3 months (P &lt; 0.05). HF-ESWT comprehensive treatment had significantly reduced edema area of ROIA on hip MRI compared with general treatment at 1, 2, and 3 months (P &lt; 0.05). In addition, the healing rate was significantly higher in the HF-ESWT comprehensive treatment group compared with general treatment group (P &lt; 0.05). One of the patients in the group treated with shockwaves developed hip pain that worsened after treatment, three patients developed local skin ecchymosis, and the other patients had no adverse events. Conclusion: HF-ESWT comprehensive treatment significantly reduced hip pain symptoms, quickly shortened the time for femoral head edema to dissipate, and significantly improved hip function for affected limbs with bone marrow edema syndrome. HF-ESWT comprehensive treatment may be an effective therapeutic strategy for HF-BMES. Keywords: Extracorporeal shock wave therapy, Bone marrow edema syndrome, Traditional Chinese medicine, Osteonecrosis of the femoral head

Natural History of Degenerative Hip Abductor Tendon Lesions

Background: The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. Hypothesis: Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. Study Design: Case series (prognosis); Level of evidence, 4. Methods: Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle’s fatty infiltration (FI) was also described. Results: From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P = .001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. Conclusion: Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions.

More Space, Less Noise-New-generation Low-Field Magnetic Resonance Imaging Systems Can Improve Patient Comfort: A Prospective 0.55T-1.5T-Scanner Comparison.

The objectives of this study were to assess patient comfort when imaged on a newly introduced 0.55T low-field magnetic resonance (MR) scanner system with a wider bore opening compared to a conventional 1.5T MR scanner system. In this prospective study, fifty patients (mean age: 66.2 ± 17.0 years, 22 females, 28 males) underwent subsequent magnetic resonance imaging (MRI) examinations with matched imaging protocols at 0.55T (MAGNETOM FreeMax, Siemens Healthineers; Erlangen, Germany) and 1.5T (MAGNETOM Avanto Fit, Siemens Healthineers; Erlangen, Germany) on the same day. MRI performed between 05/2021 and 07/2021 was included for analysis. The 0.55T MRI system had a bore opening of 80 cm, while the bore diameter of the 1.5T scanner system was 60 cm. Four patient groups were defined by imaged body regions: (1) cranial or cervical spine MRI using a head/neck coil (n = 27), (2) lumbar or thoracic spine MRI using only the in-table spine coils (n = 10), (3) hip MRI using a large flex coil (n = 8) and (4) upper- or lower-extremity MRI using small flex coils (n = 5). Following the MRI examinations, patients evaluated (1) sense of space, (2) noise level, (3) comfort, (4) coil comfort and (5) overall examination impression on a 5-point Likert-scale (range: 1= "much worse" to 5 = "much better") using a questionnaire. Maximum noise levels of all performed imaging studies were measured in decibels (dB) by a sound level meter placed in the bore center. Sense of space was perceived to be "better" or "much better" by 84% of patients for imaging examinations performed on the 0.55T MRI scanner system (mean score: 4.34 ± 0.75). Additionally, 84% of patients rated noise levels as "better" or "much better" when imaged on the low-field scanner system (mean score: 3.90 ± 0.61). Overall sensation during the imaging examination at 0.55T was rated as "better" or "much better" by 78% of patients (mean score: 3.96 ± 0.70). Quantitative assessment showed significantly reduced maximum noise levels for all 0.55T MRI studies, regardless of body region compared to 1.5T, i.e., brain MRI (83.8 ± 3.6 dB vs. 89.3 ± 5.4 dB; p = 0.04), spine MRI (83.7 ± 3.7 dB vs. 89.4 ± 2.6 dB; p = 0.004) and hip MRI (86.3 ± 5.0 dB vs. 89.1 ± 1.4 dB; p = 0.04). Patients perceived 0.55T new-generation low-field MRI to be more comfortable than conventional 1.5T MRI, given its larger bore opening and reduced noise levels during image acquisition. Therefore, new concepts regarding bore design and noise level reduction of MR scanner systems may help to reduce patient anxiety and improve well-being when undergoing MR imaging.

Extra-articular findings in patients with suspected labral tear and value of screening pelvis sequence

Objectives: There are multiple etiologies of hip pain, of which labral tear is one of the most common in young adults which may be difficult to distinguish on history and clinical examination. Labral tears can be diagnosed using high-resolution non-contrast magnetic resonance imaging (MRI) or MR arthrogram that involves imaging the concerned hip. At our institute, we perform an additional proton density fat saturated axial sequence of the pelvis to screen for alternative pathology and we investigate the value of this in this study. Material and Methods: A retrospective review of high-resolution non-arthrographic 3T MR of hips that were referred from young adult hip services with a history of hip or groin pain and the clinical suspicion of a labral tear over 2 years was performed. Those &lt;50 years were included in the study. Results: Of 648 patients with suspected labral tears, 18% showed evidence of extra-articular hip pathologies (sacroiliac joint pathology, iliopsoas pathology, and ischiofemoral impingement) on MRI. This study has shown that approximately one in five patients with a clinically suspected labral tear showed radiological evidence of extra-articular hip pathology (sacroiliac joint pathology, iliopsoas pathology, ischiofemoral impingement, and hamstring pathology). There is therefore the potential for misdiagnosis and increased morbidity if these alternative diagnoses were not appreciated. Conclusion: A high-resolution hip MRI protocol for suspected labral tears of the hip joint should include at least one sequence of the entire pelvis to evaluate for extra-articular findings.

Protocolised MRI as an adjunct to CT in the diagnosis of femoral neck fracture in high energy ipsilateral femoral shaft fractures – A break-even analysis

BackgroundIn high-energy femoral shaft fractures (FSFs), ipsilateral femoral neck fractures (FNFs) can be missed by conventional trauma computed topography (CT) imaging, resulting in increased treatment costs and patient complications. Preliminary evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to establish the economic break-even point for implementing such an MRI protocol in all high-energy FSFs. MethodsWe used an adapted break-even economic tool to determine whether the costs of a targeted MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged admission and re-operation). Sensitivity analyses were performed to demonstrate reliability of the economic modelling across a range of assumptions. ResultsAssuming a baseline of FNFs missed on CT of 12%, an MRI cost of £129 and cost of treating each missed FNF of £2457.5, the equation yielded a break-even rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 FSFs, MRI would need to diagnose 5 of the 12 missed FNF to be economically viable (number needed to treat (NNT)=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost-savings. ConclusionA rapid, limited-sequence MRI protocol to exclude occult ipsilateral FNFs in all high-energy FSFs appears to be economically justified measure. Further research exploring the feasibility of such a protocol, as well as the role of intra-operative fluoroscopy in this context, is required.