Hip Pain Scores Research Articles

The effect of musculoskeletal system disorders in female office workers

Objectives. This study aimed to analyze the effects of musculoskeletal disorders (MSDs) on the work performance, musculoskeletal fitness and quality of life of female office workers employed at a university. Methods. MSDs were evaluated in different body regions with the Cornell musculoskeletal discomfort questionnaire (CMDQ), job performance with the work role functioning questionnaire (WRFQ), musculoskeletal fitness with the musculoskeletal fitness battery (MFB) and quality of life with the short form-12 quality of life questionnaire (SF-12). Results. There was a significant weak correlation between job performance and lower back pain (LBP) (r = −0.21, p = 0.01). There were significant weak to moderate negative correlations between quality of life and CMDQ pain scores for each body part except the back, lower back and hip. There was a significant difference between those who always went to work and those who missed work for 10 days or more only in terms of LBP and hip pain scores (p = 0.008, p = 0.002). Conclusion. Musculoskeletal pain negatively impacts employees’ quality of life and work performance. Neck and extremity pain reduce office workers’ quality of life, while LBP and hip pain can affect work performance and lead to absenteeism.

Surgical treatment outcomes of acetabular posterior wall and posterior column fractures using 3D printing technology and individualized custom-made metal plates: a retrospective study

BackgroundFractures involving the posterior acetabulum with its rich vascular and neural supply present challenges in trauma orthopedics. This study evaluates the effectiveness of 3D printing technology with the use of custom-made metal plates in the treatment of posterior wall and column acetabular fractures.MethodsA retrospective analysis included 31 patients undergoing surgical fixation for posterior wall and column fractures of the acetabulum (16 in the 3D printing group, utilizing 3D printing for a 1:1 pelvic model and custom-made plates based on preoperative simulation; 15 in the traditional group, using conventional methods). Surgical and instrument operation times, intraoperative fluoroscopy frequency, intraoperative blood loss, fracture reduction quality, fracture healing time, preoperative and 12-month postoperative pain scores (Numeric Rating Scale, NRS), hip joint function at 6 and 12 months (Harris scores), and complications were compared.ResultsThe surgical and instrument operation times were significantly shorter in the 3D printing group (p < 0.001). The 3D printing group exhibited significantly lower intraoperative fluoroscopy frequency and blood loss (p = 0.001 and p < 0.001, respectively). No significant differences were observed between the two groups in terms of fracture reduction quality, fracture healing time, preoperative pain scores (NRS scores), and 6-month hip joint function (Harris scores) (p > 0.05). However, at 12 months, hip joint function and pain scores were significantly better in the 3D printing group (p < 0.05). Although the incidence of complications was lower in the 3D printing group (18.8% vs. 33.3%), the difference did not reach statistical significance (p = 0.433).ConclusionCombining 3D printing with individualized custom-made metal plates for acetabular posterior wall and column fractures reduces surgery and instrument time, minimizes intraoperative procedures and blood loss, enhancing long-term hip joint function recovery.Clinical Trial Registration12/04/2023;Trial Registration No. ChiCTR2300070438; http://www.chictr.org.cn.

Beyond the patella: Treatment of cam femoroacetabular impingement syndrome improves anterior knee pain

ObjectivesThis study aimed to investigate if there is a relationship between cam femoroacetabular impingement syndrome (cam-FAIS) and chronic anterior knee pain (AKP). MethodsThis is a pilot retrospective review of 12 AKP patients with no structural anomalies in the patellofemoral joint and no skeletal malalignment in the lower limbs. All the patients were resistant to proper conservative treatment for AKP (AKP-R). Subsequently, these patients developed pain in the ipsilateral hip several months later, and upon evaluation, were diagnosed with cam-FAIS. Arthroscopic femoral osteoplasty and labral repair were performed and clinical follow-up of hip and knee pain and function (Kujala Score and Non-arthritic Hip Score -NAHS-) was carried out. ResultsAll the patients showed improvement in the knee and hip pain scores with a statistically significant clinical difference in all of them at 69 months follow up (range: 18 to 115) except one patient without improvement in the groin VAS score post-operatively. Visual analogical scale (VAS) of knee pain improved from 6.3 (range: 5 to 8) to a postoperative 0.5 (range: 0 to 3.5), (p ​< ​0.001). The VAS of groin pain improved from 4.4 (range: 2 to 8) to a postoperative 0.9 (range: 0 to 3), (p ​< ​0.001). NAHS improved from a preoperative 67.9 (range: 28.7 to 100) to a postoperative 88 (range: 70 to 100), (p ​< ​0.015) and knee Kujala's score improved from a preoperative 48.7 (range: 22 to 71) to a postoperative 96 (range: 91 to 100), (p ​< ​0.001). ConclusionThis study's principal finding suggests an association between cam-FAIS and AKP-R in young patients who exhibit normal knee imaging and lower limbs skeletal alignment. Addressing cam-FAIS in these cases leads to resolution of both groin and knee pain, resulting in improved functional outcomes for both joints. Study designRetrospective cohort series with a single contemporaneous long-term follow-up. Level of EvidenceIV.

Effect of Enhanced Recovery After Surgery on the Prognosis of Patients With Hip Fractures: A Systematic Review and Meta-Analysis.

Hip fractures, predominantly occurring in the elderly, are a significant public health concern due to associated morbidity, disability, and mortality. Prolonged bed rest following the fracture often leads to complications, further threatening patient health. Enhanced recovery after surgery, a modern approach to postoperative care, is being explored for its potential to improve outcomes and quality of life in hip fracture patients. This study investigates the impact of enhanced recovery after surgery on hip fracture patients. In this systematic review, we addressed the PICO question: Does the enhanced recovery after surgery program reduce 1-year mortality, readmissions, and postoperative pain and improve Harris Hip Score compared with traditional care in elderly hip fracture patients? We searched key databases and gray literature and analyzed outcomes through a meta-analysis using RevMan, Stata, and the Newcastle-Ottawa Scale for quality assessment. Nine studies involving 10,359 patients were included. Compared with the control group, the enhanced recovery after surgery group showed significant reduction in length of stay (mean difference [MD] = -2.00; 95% confidence interval [CI] [-2.87, -1.14]; p < .0001) and overall complication rate (risk ratio [RR] = 0.76; 95% CI [0.67, 0.85]; p < .0001), with a lower delirium rate (RR = 0.42; 95% CI [0.26, 0.68]; p = .004). No significant differences were observed in Harris Hip Score, pain score, 1-year mortality, readmission rate, or incidences of urinary tract infection, respiratory tract infection, and deep vein thrombosis. Enhanced recovery after surgery is associated with reduced length of stay, complication rate, and delirium rate in hip fracture patients.

Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy

BackgroundIn cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison.ObjectiveA retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers.SettingPaediatric Rehabilitation Hospital in Mexico City, from August to November 2018.Participants21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls).Characteristically dataSociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips.ResultsAll children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus.ConclusionThough possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.

Short-term difference only in reported outcomes (PROMs) after anterior or posterior approach to total hip arthroplasty: a 4-year prospective multi-centre observational study

BackgroundThe direct anterior approach (DAA) in total hip arthroplasty (THA) may demonstrate better functional recovery compared to the posterior approach (PA).MethodsIn this prospective multi-centre study, patient-related outcome measures (PROMs) and length of stay (LOS) were compared between DAA and PA THA patients. The Oxford Hip Score (OHS), EQ-5D-5L, pain and satisfaction scores were collected at four perioperative stages.Results337 DAA and 187 PA THAs were included. The OHS PROM was significantly better in the DAA group at 6 weeks post-operatively (OHS: 33 vs. 30, p = 0.02, EQ-5D-5L: 80 vs. 75, p = 0.03), but there were no differences at 6 months and at 1 year. EQ-5D-5L scores were similar between both groups at all time points. LOS as inpatient was significantly different, in favour of DAA [median 2 days (IQR 2–3) vs. PA 3 (IQR 2–4), p ≤ 0.0001].ConclusionsPatients undergoing DAA THA have shorter LOS and report better short-term Oxford Hip Score PROMs at 6 weeks, but DAA did not convey long-term benefits over PA THA.

Translation of training to practice - ultrasound guided nerve block for analgesia in patients with hip fracture.

Ultrasound guided nerve blocks have been shown to be an effective analgesia option for patients with hip fracture. An education program was developed to train Emergency Department doctors and it received positive feedback from partici-pants who demonstrated competency after the training. We aimed to evaluate the education program at the behavioral level of the Kirkpatrick Model by determining the translation of training to practice of ultrasound guided nerve blocks in patients with a hip fracture at the Emergency Department. A retrospective review of medical records was carried out from 18 August 2018 to 31 December 2020. Data on patient demographics, type of hip fracture, pain score, analgesia pro-vided and complications were collected using a standardized form and analyzed. Among 634 patients, their median age was 79 years old (Interquartile range (IQR): 70 to 85) and 416 (65.6%) were female. The median pain score was 6 (IQR: 5 to 8) and analgesia was provided for 561 (88.5%) patients. Analgesia was administered most frequently via the intravenous route (n=407, 72.5%) and tramadol (n=293, 52.2%) was most commonly used. Ultrasound guided nerve block was performed in 26 (4.7%) patients - all were performed successfully without complications. The utilization increased from 1.0% before to 4.7% after the conduct of the training workshops (p=0.16). A significant gap still exists in the translation of training to practice. Barriers must be identified and overcome so that ultimately, the education program can bring about an organizational impact to benefit patients and improve their outcomes.

Youth sport specialization associated with poorer lower extremity function & pain as young adults

ABSTRACT Objective Examine the link between youth sports specialization and long-term lower extremity joint health after sports by comparing lower extremity function, pain, and history of sport-related injuries between young adults that were highly, moderately, and low specialized in youth sports. Methods We used a cross-sectional design, and all data was collected using an electronic survey. Our sample included N = 356 young adults who participated in a primary sport during youth and high school sports but were no longer participating in that sport as a young adult. Participants were stratified into high (n = 111), moderate (n = 119), and low (n = 126) specialization groups using a 3-criteria sport specialization questionnaire based on youth sports participation prior to high school. We compared participants current Lower Extremity Functional Scale (LEFS) score (0–80), the proportion of participants with clinically important deficits in LEFS score (≤71/80), current lower extremity (foot/ankle, knee, hip) pain scores (0–10), and history of lower extremity (foot/ankle, knee, hip) injuries between the high, moderate, and low specialization groups. Results The high specialization group reported significantly lower overall LEFS scores, and a greater proportion (40%) reported clinically important deficits in LEFS scores compared to the low specialization group (20%). The high specialization group also reported greater foot/ankle and knee pain and a greater proportion of sport-related knee injuries than the low specialization group (49% vs 25%). Conclusions Our findings suggest that even after discontinuing sports, young adults who were highly specialized in youth sports before high school reported clinically important deficits in lower extremity function, greater foot/ankle and knee pain, and a greater history of knee injuries than young adults who were not specialized in youth sports, suggesting a possible link between youth sports specialization and long-term lower extremity health after sports.

Effect of flurbiprofen axetil combined with "Cocktail" therapy on opioid dosage in patients after total knee arthroplasty.

Objectives:To investigate the effect of flurbiprofen axetil combined with “cocktail” therapy on opioid dosage in patients after total knee arthroplasty (TKA).Methods:The clinical data of 200 patients who underwent TKA in Baoding No.1 Central Hospital hospital from March 2019 to March 2021 were collected for retrospective analysis. All 200 patients were divided into two groups according to their intraoperative anesthesia methods: the control group (100 cases) and the experimental group (100 cases). Patients in the control group were treated with “cocktail” therapy intraoperatively, while those in the experimental group were treated with flurbiprofen axetil combined with “cocktail” therapy intraoperatively. The hip pain scores in resting state and motion state were compared between the two groups at different postoperative time points, and postoperative pain relief, adverse reactions, and patient satisfaction with analgesia were statistically analyzed to evaluate the postoperative quality of life of the patients.Results:A statistically significant difference was observed in the intergroup and temporal effects of pain scores in resting state and motion state between the two groups (p<0.05). By comparison at each time point, the pain scores in the experimental group were significantly lower than those in the control group at the time point T1-T6 in resting and motion states, with a statistically significant difference (p<0.05). The frequency and dosage of remedial medication per capita in the experimental group were significantly lower than those in the control group, with a statistical significance (p<0.05). There was no significant difference in the scores of life quality items between the two groups preoperatively (p>0.05), while the scores of each item in the experimental group were significantly higher than those in the control group postoperatively (p<0.05). The satisfaction degree of the experimental group was significantly higher than that of the control group, showing a statistically significant difference (p<0.05).Conclusions:Flurbiprofen axetil combined with “cocktail” therapy is a safe treatment regimen that can improve the quality of life and safety of patients. With such a regimen, postoperative pain of patients undergoing TKA can be effectively relieved, and the use of opioids can be reduced.

Long-Term Clinical Outcomes and Survivorship of Total Hip Arthroplasty for Pyogenic Arthritis: A Retrospective Cohort Study of 168 Hips.

ObjectiveThe aim of the present study was to evaluate the 10‐year outcomes of cementless total hip arthroplasty (THA) in adult patients with the late sequelae of septic arthritis of the hip.MethodsWe followed 166 consecutive patients (168 hips) who underwent cementless THA between March 2001 and December 2011. There were 79 men and 87 women, with a mean age of 50.4 years (range 21–76 years) at the time of index THA, all of whom had hip osteoarthritis secondary to hip pyogenic infection. The average duration of follow up was 10.6 years (range 6.9–17.2 years). Preoperative and postoperative clinical ratings were evaluated, including the hip dysfunction and osteoarthritis outcome score (HOOS), the Harris hip score (HHS), range of motion, a 100‐point visual analog scale for hip pain, and the severity of limp and limb length discrepancy (LLD). The anteroposterior and lateral radiographs of the hip and full‐length view of the lower extremities were obtained to assess the position of the components, radiolucent lines, osteolysis, loosening of components, and heterotopic ossification. The intraoperative and postoperative complications were also recorded.ResultsThe mean HSS and hip pain score were 44.2 points (range 29–66 points) and 42.5 points (range 32–64 points), respectively, before the index surgery and significantly improved to 88.1 points (range 78–96 points) and 15.1 points (range 10–26 points), respectively, at final follow‐up examination. The HOOS and range of motion also improved significantly. The mean limb length discrepancy was reduced from 2.6 to 0.8 cm. The limp at last follow‐up examination was moderate in 3 cases because of hip osteoarthritis in the other limb, slight in 26, and absent in 137. A radiolucent line was observed in 12 hips (7.1%) around the acetabular or femoral components. A progressive radiolucent line around the undersized femoral stem in all zones was seen in 1 hip, resulting in aseptic loosening and breakage of the femoral component. There were 8 cases of intraoperative fracture, 7 cases of dislocation, and 7 cases of transient nerve palsy. Recurrence of infection occurred in 2 hips. Revision surgery was conducted in 2 hips because of isolated loosening of the acetabular cup and the femoral stem, respectively. Kaplan–Meier survival was 97% at 10 years, with revision for any reason with any component as an end‐point.ConclusionImproved surgical techniques and development of components with various sizes provided favorable results for cementless THA conducted for late sequelae of sepsis in these young and active patients. Although the incidence of complications was relatively high, the complications were treated successfully.

Mid-term results of total hip arthroplasty with subtrochanteric Z-osteotomy in Crowe type 3-4 developmental hip dysplasia

Background/aim Total hip arthroplasty (THA) is technically more difficult and has higher complication rates in patients with Crowe type 3–4 developmental dysplasia of the hip (DDH). Due to the difficulties and different treatment options, there is still no consensus on the optimal treatment. We aimed to evaluate the mid-term results of our patients who had undergone subtrochanteric femoral shortening Z-osteotomy.Materials and methods This study included 37 hips of 29 patients with the diagnosis of Crowe 3-4 DDH between June 2010 and December 2016 and who underwent femoral shortening Z-osteotomy with cementless total hip arthroplasty. Acetabular component was determined according to the patient’s age and functional capacity and all patients were operated with a posterior approach. Functional results, postoperative complications, Harris and visual analogue scale (VAS) scores were evaluated. Results The average Harris hip score was 41.3 ± 3.1 preoperatively and 84.7 ± 4.3 postoperatively (p < 0.05). The mean preoperative hip pain score on the VAS was 7.9 (range: 6–9) and this was significantly lower at the last follow-up (mean: 3.4; range: 2–4) (p < 0.05). The final mean limb-length discrepancy was 1.3 cm. The average amount of femoral shortening was 3.2 cm. Regarding complications, 3 (10.3%) patients had dislocations. These patients underwent closed reduction. Sciatic palsy developed in 1 (3.4%) patient. The patient was reoperated on for sciatic nerve dissection in the early period.Conclusion Subtrochanteric shortening Z-osteotomy combined with cementless total hip replacement can be considered an effective and successful method in selected patients with Crowe 3-4 coxarthrosis.

Short-term changes in radiographic joint space width after jiggling exercise as conservative treatment for hip osteoarthritis: A retrospective case series of nine patients.

Jiggling exercise is a conservative treatment for hip osteoarthritis, which involves continuous shaking of the foot and leg in small oscillations while seated. Previous studies have shown beneficial effects of jiggling exercises for outpatients with advanced- and terminal-stage hip osteoarthritis when performed for longer than 1 year, including increases in joint space width and remission of symptoms. We aimed to use the data from our own treatment to evaluate the short-term impact of intensive jiggling exercises on inpatients with hip osteoarthritis to further examine the clinical utility of this exercise. This retrospective case series study included nine patients (57 ± 12 years) with nine hip joints with advanced- or terminal-stage hip osteoarthritis who performed continuous daily jiggling exercises, beginning from day of hospitalization to 6 months post-discharge. Jiggling exercise was performed seated, using the KENKO YUSURI® automated heel vibrating machine at 3.3–5.0 Hz. The patients were also instructed against weight-bearing during hospitalization. The values of radiographic joint space width and Japanese Orthopaedic Association hip score for pain at hospital admission, discharge, and at the 6-month post-discharge checkup were evaluated. Although the hospitalization period and daily time spent performing the jiggling exercise varied in each case (27–98 days and 2–6 hours, respectively), the joint space width increased in all patients and there was an improvement in the hip pain scores in eight patients. The mean values of the minimum joint space width and hip pain scores at discharge were the highest compared to those at hospital admission and 6 months post-discharge. Our results suggest that intensive jiggling exercise for inpatients with advanced- and terminal-stage hip osteoarthritis leads to earlier improvement in joint space width and pain. Daily jiggling exercise for an adequate duration or in combination with non-weight-bearing practices may be a feasible conservative treatment for hip osteoarthritis.

Posterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial.

Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty. This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events. There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (β = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events. After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen.

Prior hip arthroscopy does not affect 1-year patient-reported outcomes following total hip arthroplasty: a register-based matched case-control study of 675 patients

Background and purpose — Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and may contribute to the development of osteoarthritis. We investigated whether a prior hip arthroscopy affects the patient-reported outcomes (PROMs) of a later total hip arthroplasty (THA). Patients and methods — Patients undergoing hip arthroscopy between 2011 and 2018 were identified from a hip arthroscopy register and linked to the Swedish Hip Arthroplasty Register (SHAR). A propensity-score matched control group without a prior hip arthroscopy, based on demographic data and preoperative score from the EuroQoL visual analogue scale (EQ VAS) and hip pain score, was identified from SHAR. The group with a hip arthroscopy (treated group) consisted of 135 patients and the matched control group comprised 540 patients. The included PROMs were EQ-5D and EQ VAS of the EuroQoL group, and a questionnaire regarding hip pain and another addressing satisfaction. Rate of reoperation was collected from the SHAR. The follow-up period was 1 year. Results — The mean interval from arthroscopy to THA was 27 months (SD 19). The EQ-5D was 0.81 and 0.82, and EQ VAS was 78 and 79 in the treated group and the matched control group respectively. There were no differences in hip pain, and reported satisfaction was similar with 87% in the treated group and 86% in the matched control group. Interpretation — These results offer reassurance that a prior hip arthroscopy for FAIS does not appear to affect the short-term patient-reported outcomes of a future THA and indicate that patients undergoing an intervention are not at risk of inferior results due to their prior hip arthroscopy.

Hip pain in adolescents with cerebral palsy: a population-based longitudinal study.

AimTo investigate the prevalence, characteristics, and risk factors of hip pain in adolescents with cerebral palsy (CP) and compare the findings with those of the same individuals 5 years earlier.MethodSixty‐seven adolescents (28 females, 39 males; mean age 14y 7mo; SD 1y 5mo; range 12–17y) with bilateral CP, in Gross Motor Function Classification System (GMFCS) levels III to V enrolled in a CP surveillance programme were assessed for hip pain. Their caregivers responded to the questions on the intensity and frequency of hip pain from the Child Health Questionnaire (CHQ) (transformed to CHQ hip pain score; 100 indicates no pain). Interference of hip pain with daily activities and sleep was recorded on numeric rating scales. Hip displacement was measured radiographically by the migration percentage.ResultsTwenty‐eight participants had 44 painful hips. Their mean CHQ hip pain score was 40 (SD 21.4; range 10–80). Independent risk factors for hip pain, low CHQ hip pain score, and interference with sleep were severe hip subluxation (migration percentage 50–89%) and GMFCS level V. A migration percentage of 50% to 89% was the only independent risk factor for interference with daily activities. Over 5 years, the number of participants with hip pain increased from 18 to 28, while the mean migration percentage of the most displaced hip was unchanged.InterpretationOur CP hip surveillance programme did not protect the participants against increasing prevalence of hip pain during adolescence. We suggest that surveillance programmes for CP should include guidelines on the characteristics and management of hip pain.What this paper adds Hip pain prevalence increased in adolescents over a 5‐year period in a cerebral palsy surveillance programme.Risk factors for hip pain were Gross Motor Function Classification System level V and severe hip subluxation.

Anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis after total hip arthroplasty: a cohort study.

BackgroundLittle is known about the anatomical changes in lumbosacral vertebrae and their correlation with facet joint-derived low back pain in patients with hip osteoarthritis (HOA) after total hip arthroplasty.MethodsSeventy-four HOA patients with low back pain who underwent initial total hip arthroplasty were included. Their Harris Hip Score (HHS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) and anatomical parameters were analyzed. Paired t-tests were used to compare the various index scores before and after surgery, and independent sample t-tests were used for the between-group comparisons.ResultsThe HHS and ODI significantly changed at 3 and 6 months postoperatively [HHS: preoperative (43.56±4.34) vs. 3 months (80.34±5.23) vs. 6 months (84.37±4.78); ODI: preoperative (36.26±5.34) vs. 3 months (26.44±3.23) vs. 6 months (19.34±3.27); P<0.001]. At the first 3 months after surgery, the VAS low back pain score decreased from 5.24±1.21 to 2.89±1.03 (P<0.001), and the VAS hip pain score decreased from 7.45±1.32 to 2.34±1.12 (P<0.001). There was also a statistically significant difference between the preoperative and 1-month postoperative anatomical indices: lumbar lordosis (LL) increased significantly after surgery [preoperative (43.46°±13.89°) vs. 1 month (48.27°±14.42°), P=0.001], while slip angle (SA) decreased significantly [preoperative (89.20°±5.03°) vs. 1 month (84.45°±4.89°), P=0.010]. Sacral slope (SS) and radial abduction angle (RAA) showed significant postoperative changes compared with preoperative assessments; after surgery, SS increased significantly [preoperative (31.33°±8.23°) vs. 1 month (37.65°±8.19°), P=0.006), while RAA decreased significantly [preoperative (42.32°±8.12°) vs. 1 month (35.45°±7.67°), P=0.021]. Moreover, the increase of LL was both significantly correlated with the decrease of the VAS low back pain (P=0.009) and the VAS hip pain score (P=0.038).ConclusionsTotal hip arthroplasty was associated with the anatomical changes in lumbosacral vertebrae.

Ultrasound Alpha Angles and Hip Pain and Function in Female Elite Adolescent Ballet Dancers.

Femoroacetabular impingement (FAI) is a common anatomical variant in ballet dancers. Cam morphology (a subtype of FAI) and increased alpha angles have been identified as risk factors for hip pain. Ultrasound has recently been used to measure alpha angles in the diagnosis of cam morphology, but its utility remains understudied. The purpose of this study was to investigate the effect of ultrasound measured alpha angles on hip pain and function scores in elite female adolescent ballet dancers. The alpha angles of 25 dancers (mean age: 15.9 years) were measured using ultrasound and calculated with ImageJ Software. Cam morphology was defined by alpha angles of 60° or greater. Participants rated their hip pain and function using the International Hip Outcome Tool 12 (iHOT-12) survey. For normally distributed variables, the independent t-test was performed, and for abnormally distributed variables, the Mann-Whitney U Test. Along with mean and standard deviation (SD) values, median score, interquartile range (IQR), and 95% confidence intervals (95% CIs) were also analyzed. Significantly lower iHOT-12 scores were found in dancers with alpha angles ≥ 60° (mean ± SD, 74.34 ± 13.01; 95% CIs, 58.18, 90.50, median 67.20; IQR, 18.55), compared to dancers with alpha angles < 60° (mean ± SD, 80.22 ± 15.65; 95% CIs, 72.90, 87.54; median, 81.60; IQR, 16.35; p = 0.001). It is concluded that: 1. elite female adolescent ballet dancers with alpha angles higher than 60° experienced worse hip pain and function; 2. alpha angles may impact hip pain and function in these dancers; and 3. further studies should use a prospective design to investigate the predictive ability of their findings.

Hip Joint Cartilage Defects in Professional Ballet Dancers: A 5-year Longitudinal Study.

A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years. Longitudinal. Professional ballet company. Twenty-one professional ballet dancers (52% men). Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS-pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI). Change in cartilage defect score on MRI between baseline and 5-year follow-up. Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004]. Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects. 1b.

Five-Year Follow-Up of Clinical Outcomes with an Anatomic Dual-Mobility Acetabular System: A Multicenter Study.

BackgroundThe dual-mobility implant system has been shown to increase impingement-free range of motion and decrease dislocation risk by increasing the effective head size. In addition, the anatomic dual-mobility (ADM) cup offers relief between the acetabular shell rim and the iliopsoas tendon. This study was designed to review a series of hips implanted with the ADM acetabular cup to examine clinical outcomes after 5 years of implantation at multiple orthopaedic centers.MethodsWe retrospectively queried our prospectively collected total joint arthroplasty registry for patients who underwent total hip arthroplasty with an ADM cup from January 2008 to December 2012 at 4 different orthopaedic institutions and who had minimum 5-year follow-up. Harris Hip Scores and visual analog scale scores were evaluated. Postoperative complications, dislocations, and revisions for any reason were recorded.ResultsA total of 142 patients had a mean follow-up of 5.7 years (range: 5.0 to 8.0 years). Radiographic analysis showed no radiolucent lines, osteolysis, or acetabular loosening. There were no dislocations in this patient series. Two (1.2%) hips required a revision because of adverse local tissue reactions related to corrosion from a recalled modular neck stem, but this was unrelated to the ADM cup. The mean Harris Hip pain scores increased from 17 points preoperatively to 39 points at the most recent follow-up (P < .001). The mean Harris Hip function score increased from an average of 29 points preoperatively to 38 points at the most recent follow-up (P < .001). The mean visual analog scale score showed patient improvement from 6.5 preoperatively to 1.2 postoperatively (P < .001).ConclusionsADM prostheses were designed to reduce the risk of dislocation by increasing the size of the effective femoral head. In this multicenter study of ADM cups used in primary total hip arthroplasty, we demonstrated good clinical and radiographic outcomes, no dislocations, and no revisions at midterm 5-year minimum follow-up. Patient-reported outcome measures were also improved, supporting the use of this implant.

Outcomes Following the Urgent Surgical Management of Displaced Femoral Neck Stress Fractures.

To review the clinical course, complication rates, and mid-term functional outcomes associated with the treatment of displaced femoral neck stress fractures (FNSFs). Retrospective Case Series. Military Tertiary Referral Center. Twenty-one operatively treated displaced FNSFs between 2002 and 2015. Urgent reduction and fixation was performed. If nonunion developed, an intertrochanteric osteotomy was performed. Nonunion, osteonecrosis (ON) of the femoral head, conversion to arthroplasty, modified Harris Hip Score, pain score, and Hip Outcome Score (HOS). Two (9.1%) patients developed nonunion. Both united after revision with intertrochanteric osteotomy. ON developed in one patient (4.8%) who was converted to arthroplasty. Average pain score at final follow-up was 2.0 (range 0-5). Average Modified Harris Hip Score was 84 (range 54-100). Average HOS Activities of Daily Living subscale was 80.9 (range 45.6-100). Average HOS Sport subscale was 69.8 (range 27.8-100). Larger displacement on injury films correlated with lower Modified Harris Hip Scores (P = 0.048) and lower HOS Sports Subscale Single Assessment Numeric Evaluation (P = 0.023). The need for an open reduction trended toward being a risk factor for nonunion (P = 0.081). This study represents the largest series of patients undergoing urgent surgery for displaced FNSFs. Nonunion and ON is found at a similar rate to what is reported in the young traumatic literature. Pain and outcome scores compare favorably to other hip pathology in young adults. Initial injury severity is variably correlated to final outcome scores. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.