Neuroblastoma is the second most common childhood malignancy. Only a minority of children with metastatic disease present initially to orthopedic surgeons, despite musculoskeletal complaints such as back pain, limb pain, limp, extremity swelling, or findings mimicking osteomyelitis. These vague and nonspecific presentations increase the risk of delayed diagnosis. To study orthopedic manifestations that present as the initial presenting symptoms of neuroblastoma in children and to characterize their clinical, radiological, and laboratory profiles. Forty-six consecutive patients with neuroblastoma were retrospectively evaluated. Medical records were reviewed, with particular attention given to the presence of orthopedic manifestations preceding the diagnosis of neuroblastoma. The children who were presented primarily to the orthopedics department were identified. The details of musculoskeletal symptoms and radiological and laboratory investigations were analyzed. Seven children (20%) presented initially with orthopedic complaints. Three patients had spinal involvement, including paraplegia from hydromyelia or vertebral metastasis with lytic-sclerotic lesions. Three children presented with persistent hip pain and limp and were initially diagnosed with osteomyelitis before biopsy confirmed neuroblastoma. One child presented with nontraumatic forearm swelling, initially presumed as osteomyelitis, with radiographs showing lysis of the ulnar metaphysis. A biopsy was used to establish the diagnosis. Six children had severe anemia with elevated ESR and CRP, and three had markedly elevated LDH levels. Approximately one-fifth of children with neuroblastoma initially present to orthopedic surgeons. Persistent or atypical musculoskeletal complaints-especially hip pain or back pain accompanied by anemia, high ESR, or high CRP-should prompt the consideration of neuroblastoma and early histopathological evaluation to avoid diagnostic delays.

Bracing is a conservative treatment method for hip osteoarthritis (HOA) and has shown favourable effects on pain and functional capacity. However, biomechanical analyses of brace effects remain sparse and are limited to level walking. Stair walking is more demanding than level walking in terms of movement coordination and joint loads. This study, therefore, aimed to investigate the effect of hip bracing on pain perception and biomechanics of the hip, pelvis, and trunk during stair walking in individuals with HOA. Hip, pelvis, and trunk biomechanics and pain during stair ascent and descent were assessed before and after one week of hip bracing in 20 individuals with unilateral mild-to-moderate HOA. Differences between the bracing conditions were analysed with dependent t-tests, and Pearson's correlations were used to analyse the correlation between brace-induced alterations in pain score and biomechanical parameters. Bracing increased movement velocity and reduced stair walking pain by 28%. Furthermore, increased hip extension and reduced hip flexion were found with bracing. Bracing led to a decrease in anterior pelvis tilt, resulting in a more upright pelvis position. Trunk motion was not affected by bracing. During stair ascent, frontal pelvis motion increased, while peak hip adduction and internal rotation decreased with bracing. During stair descent, increased hip extension and external rotation moments were found with bracing, while the pelvis and hip transverse range of motion were reduced. Decreased pelvis rise on the ipsilateral side during stair ascent and increased hip transverse range of motion during stair descent were moderately correlated with a decrease in pain. Bracing can reduce hip pain during stair walking and mitigate some of the effects of HOA on stair walking biomechanics, making it a valuable conservative treatment option for individuals with mild-to-moderate HOA. Limiting hip internal rotation exclusively during periods of high joint loading could be a promising mechanism for reducing pain in individuals with HOA. The observed biomechanical changes are indicative of altered hip abductor muscle activity and increased joint loading. Hence, further analyses are necessary to explore the relationship between hip bracing, muscle activity, joint loading and pain.

ABSTRACT Objective The primary objective of this study was to describe the musculoskeletal health of retired elite women’s footballers, with a particular emphasis on hip, knee and ankle pain and function. Methods Retired elite women’s footballers (18 years or older) were surveyed on their history of severe hip, knee and ankle injuries, and previous joint surgery. Validated questionnaires (e.g. Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS)) were used to assess health outcomes, such as level of function and pain. Results 62 respondents completed the survey (mean age 35.5 years, mean age at retirement 30.5 years). Nineteen (30.6%) retired players reported experiencing hip pain at least once per month. Forty-four (71%) participants had at least one severe knee injury during their career, with nearly a third (n = 20, 32.3%) experiencing knee pain on a weekly basis. The majority (n = 48, 77.4%) of participants had experienced at least one severe ankle injury during their career. Hip, knee and ankle pain was associated with a history of severe hip, knee or ankle injury during a playing career. A history of ankle surgery was associated with ankle pain. Mean KOOS-PS score (84.7) was lower than that seen in the general population, while hip/ankle outcome measures were comparable to the general population. Conclusion Musculoskeletal complaints, especially knee-related issues, are common amongst retired elite women’s footballers, and are associated with severe injuries during a player’s career. Collaborative injury prevention efforts are likely to lead to positive health benefits for current, future and former elite women’s footballers.

In 2023, the first North American Hip Arthroscopy Registry was released: the Hip Surgical Treatment Registry (HipSTR). HipSTR is a prospective web-based data collection registry designed to gather baseline patient information, procedural data, and surgical outcomes. To present the initial demographic and surgical overview data for patients enrolled in 2023. Cohort study; Level of evidence, 3. Beta testing of HipSTR occurred between February 2023 and July 23, 2023, by 7 surgeons on >400 patients. Starting July 23, 2023, HipSTR was made available for enrollment by North American orthopaedic surgeons. HipSTR is a free, digitally administered registry integrated with cloud-based (Patient IQ) outcome database capturing preoperative demographics, patient-reported outcome (PRO) measures, and intraoperative surgical data. As of December 31, 2023, 14 surgical sites with 21 participating surgeons were enrolling hip arthroscopy patients, totaling 1098 patients in the calendar year 2023. The registry included 65% female patients and 34% male patients, with a mean age of 36.6 ± 14 years. Baseline compliance was 90%. Mean preoperative PRO measures (the 12-item International Hip Outcome Tool, EuroQol 5 Dimension 5 Level Visual Analog Scale, and Hip Single Assessment Numeric Evaluation scores) were 39.7 ± 19.0, 69.6 ± 19.6 and 39.1 ± 21.7, respectively, indicating the significant impact of their hip pain. In total, 315 patients described themselves as an athlete. Surgical findings revealed a variety of hip pathology, including 45% CAM lesions, 43% labral tears, 38% acetabular chondral lesions, 26% pincer morphology. Among patients with CAM and pincer/anterior inferior iliac spine morphology, 98% and 75% underwent femoral osteoplasty and acetabuloplasty, respectively. Additionally, 56% of all patients with acetabular cartilage injury underwent acetabular chondroplasty and 9% underwent microfracture. Notably, 16% of patients had prior surgery on their affected hip. Formal capsulotomies were performed in 68.3% of patients and of these, 83% had their capsulotomy fully repaired. These findings provide initial insights into the demographics and clinical profiles of North American patients undergoing hip arthroscopy as well as the types of procedures performed. These data, along with future contributions as the registry expands, will enhance understanding of the pathologies managed with hip arthroscopy, evaluate PRO measures to assess procedural efficacy, and guide efforts in the prevention and management of hip pain.

Background: This study aimed to investigate the association between femoroacetabular impingement (FAI) morphology and femoral head bone marrow edema of unknown etiology on hip magnetic resonance imaging (MRI), and to assess the added value of computed tomography-based three-dimensional maximum intensity projection (CT-MIP) measurements in identifying a predisposition to acetabular overcoverage. Methods: Hip MRI examinations performed between January 2007 and 2025 were retrospectively reviewed. Cases with bone marrow edema attributable to identifiable etiologies were excluded. Twenty-six patients with available hip or pelvis computed tomography (CT) examinations obtained within one year were included, along with an age- and sex-matched control group imaged for indications unrelated to hip pain. A total of 104 hip joints were evaluated. Alpha angles were measured on axial oblique CT reformations. Virtual pelvic radiographs generated from CT-based three-dimensional reconstructions were used for lateral center-edge angle (LCEA) measurements, and acetabular coverage was quantified using the acetabular coverage index derived from CT-MIP images. Appropriate statistical analyses were performed, with p < 0.05 considered statistically significant. Results: FAI was identified in 82.7% of cases with bone marrow edema of unknown etiology on MRI (p < 0.001), with pincer-type morphology being the most prevalent subtype (55.8%). Bone marrow edema was significantly more common in pincer-type FAI compared with other subtypes (p < 0.001) and predominantly involved the posterolateral femoral head. Mean alpha angle, LCEA, and acetabular coverage index values were significantly higher in the case group than in controls (p < 0.001). For the detection of pincer-type FAI, CT-MIP-based acetabular coverage index demonstrated superior diagnostic performance compared with LCEA (AUC, 0.917 vs. 0.855; p = 0.017), with an optimal cutoff value of 0.93 yielding high specificity and accuracy. All measurements showed excellent intraobserver and interobserver reliability. Conclusions: Femoral head bone marrow edema of unknown etiology may serve as a radiologic clue to underlying pincer-type FAI, while CT-MIP-based analyses may provide incremental value beyond conventional angular measurements in characterizing acetabular overcoverage.

Comparison of dynamic neuromuscular stabilization exercises with and without the feldenkrais method on pain, balance, and hip muscle strength in elderly women with chronic non-specific low back pain.

Hip pain in children - a structured approach for primary care practitioners

Hip pain in adults - a structured approach for primary care practitioners

Late hemorrhage after radiofrequency denervation for chronic hip pain: A CASE report

Comparison of image quality, radiation dose and repeat rates for anteroposterior (AP) pelvic radiography imaging techniques (STOPPAGE study).

ABSTRACT Intertrochanteric fractures, characterized by breaks in the proximal femur outside the joint capsule, present significant rehabilitation challenges, especially in older adult with comorbidities. These fractures disrupt the attachment points for major muscles and can lead to complications if not promptly and effectively treated. This case report explores the complex clinical scenario of a 58-year-old female patient with a history of Type 2 diabetes mellitus (T2DM) and tuberculosis, who suffered a closed intertrochanteric fracture dextra. The complications were exacerbated by neurogenic bowel disorder (NBD) due to prolonged immobility. The patient presented to the emergency department with severe hip pain following a fall at home, where she had been bedridden for two weeks. During this time, she developed a grade 2 decubitus ulcer. Despite her painful condition, initial treatment was delayed, leading to severe complications. A subsequent chest X-ray revealed infiltration along with atelectasis of the left superior lobe and left pleural effusion indicative of exacerbated pulmonary tuberculosis. Diagnostic imaging also identified an obstructive ileus. Immediate surgical intervention was indicated to manage the fracture. In addition to surgical care, the patient required specialized nursing care to address her acute and chronic medical needs, including blood glucose monitoring and management of her pulmonary condition. Prior to her surgery, Swadesh massage therapy was employed, resulting in minor relief indicated by the passage of a small amount of hard, mucous-like feces. Effective management of closed intertrochanteric fractures in patients with significant comorbidities requires a multidisciplinary approach. Early surgical intervention, combined with tailored nursing care and continuous monitoring of associated complications, is crucial for restoring functionality and preventing further health deterioration. Keywords: Intertrochanteric Fracture, Neurogenic Bowel Disorder, Type 2 Diabetes Mellitus, Pulmonary Tuberculosis, Multidisciplinary Care.

Femoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data. To compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome. Systematic review and Meta-analysis; Level of evidence, 3. A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA). Nine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature. Simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile. PROSPERO (CRD420251039957).

A 68-year-old man with left hip pain

Acetabular fractures in children are extremely rare, accounting for approximately 1%-4.6% of all pediatric fractures. Due to their rarity, literature on these injuries is limited, with only a few reported cases. The primary objective of this study was to present a series of uncommon pediatric injuries, outline our management approach, and demonstrate that even patients undergoing delayed surgical intervention can achieve favorable clinical outcomes. This retrospective study reviewed records of skeletally immature patients with traumatic acetabular fractures treated at our institution. Patients were surgically treated with open reduction and internal fixation through lateral rectus abdominis approach; follow-ups included radiological assessment of bone union and internal fixation integrity. Postoperative reduction was evaluated using Matta's criteria, while functional outcomes were measured via the Modified Merle d'Aubigné and Postel Method (pain, gait, mobility) and the Harris Hip Score (HHS). Complications were documented throughout follow-up. Between January 2019 and January 2025, 14 pediatric patients with acetabular fractures (five males, nine females; mean age 11.42 ± 2.24 years) were treated and followed for an average of 33.71 ± 14.41 months. Injuries resulted from falls (57.14%), car accidents (28.57%), and motorcycle/bicycle accidents (7.14% each). According to Judet and Letournel classification, fractures included double-column (57.14%), transverse (35.72%), and anterior with posterior hemi-transverse (7.14%). All underwent surgery, achieving bone union. The mean Harris Hip Score was 90.35 ± 5.58, with 71.42% rated excellent, 21.42% good, and 7.14% fair. The mean Merle d'Aubigné score was 17.21 ± 1.12. Mild hip pain occurred in three patients, with no other complications. Pediatric acetabular fractures, typically caused by high-energy trauma, require treatment focused on optimal outcomes and anatomical reduction, even in delayed cases. This study shows that, in specialized centers, experienced surgical teams can achieve successful reduction and satisfactory results despite delayed intervention.

Does presence of hip dysplasia affect the prevalence and location of cam morphologies in pediatric hip pain patients?

Despite the increasing use of MARS (metal artifact reduction sequence) MRI to investigate painful total hip arthroplasties (THA), no validated criteria exist for diagnosing femoral stem loosening. To evaluate MARS MRI for the diagnosis of aseptic stem loosening and determine its diagnostic accuracy. One hundred fourteen consecutive cases with THA revision surgery and MARS MRI of the hip were retrospectively included. Two blinded musculoskeletal radiologists independently assessed periprosthetic bone resorption (PPBR), bone marrow edema (BME), periosteal reaction (PR), and periprosthetic osteolysis (PO) in 14 Gruen zones (GZ). Intraoperative findings at revision surgery served as the ground truth. A predictive model was created using binomial logistic regression models to predict the probability of a loose stem with maximizing positive predictive value (PPV) and accuracy. Interobserver reliability was assessed with absolute agreement, Cohen κ and Gwet AC1. During surgery, 66 stems were fixed and 48 loose. PPBR occurred significantly more frequently in loose stems across all GZs except GZ11. Proximal PPBR was also observed in fixed stems (up to 23%), whereas middle and distal PPBR were rare (≤3%). BME was most prevalent proximally in all stems (fixed/loose: 39%/60%) with significant differences medially and distally. PR was significantly more frequent in loose stems in the middle and distal GZs. PO were rare, most occurred in GZ7. The predictive model considering proximal PPBR, mid-distal PPBR, mid-distal PR, and distal BME performed with a sensitivity of 0.708, specificity of 0.970, PPV 0.944, negative predictive value 0.821. Interobserver agreement (Gwet AC1) in the considered zones was for PPBR between 0.80 and 0.98, BME 0.91 to 0.99, PR 0.87 to 0.97. MARS MRI is reproducible and accurate for assessing stem loosening. PPBR, BME, and PR can also be found in fixed THA in the proximal region, whereas they indicate loosening in the middle and distal stem region.

Patient-reported outcome measures (PROMs) are increasingly used to assess treatment effectiveness in various domains from the patients' perspective. This systematic review aimed to identify what PROMs have been used in hip fracture clinical trials, whether they are used as the primary outcome, whether validity evidence is referenced and how their use has changed over time. Studies obtained from PubMed, Embase, and Web of Science published between 01/01/2010 and 29/09/2025 were assessed. Eligible studies were controlled trials on hip fracture interventions in adult populations published in English. We checked the reference for validity evidence of PROMs used in included studies. Characteristics of each study were extracted, and PROMs usage was summarised by year of publication. A total of 28 different PROMs were used in 189 trials, with each covering different outcome domains. The most used PROMs were Harris hip score, EuroQoL-5D and pain visual analogue scale. A predominant proportion of studies (n = 162, 85.7%) utilised at least one PROMs, including 65 studies used multiple PROMs. There is an increasing trend of PROMs usage in trials and the number of papers using a PROM as a primary outcome over time. However, 95 studies did not reference any validity evidence for PROMs used. The frequent usage of PROMs in trials, and often as a primary outcome, suggests patient perspective is valued when evaluating hip fracture intervention. However, the lack of a single PROM covering all outcome domains necessitates using more than one PROMs in the included trials. A more comprehensive PROM or a core set of PROMs that measures all patient-related outcomes would achieve a holistic assessment and the ability to make direct comparisons between different interventions.

IntroductionPrimary hyperparathyroidism is usually caused by parathyroid adenomas, however atypical tumors are rare. Brown tumors can occur from excessive parathyroid hormone release, which increases osteoclastic bone resorption. Although rare, atypical parathyroid tumors can cause such lesions. An unusual parathyroid tumor with a brown tumor is shown here.Clinical CaseA 57-year-old woman presented to the orthopedics clinic with complaints of left hip pain. Imaging revealed a mass in the left acetabulum. Laboratory tests suggested primary hyperparathyroidism, and she was referred to endocrinology with a suspected brown tumor.Left hip pain had been present for 1.5 years, with recent worsening, causing difficulty in walking. Her medical history included percutaneous nephrolithotripsy for nephrolithiasis. Physical examination revealed painful and restricted movements of the left hip. Laboratory investigations demonstrated: calcium 13.2 mg/dL (8.8–10.6), phosphorus 2.2 mg/dL (2.5–4.5), PTH 883 ng/L (15–65), 25-OH vitamin D 35.2 μg/L, creatinine 1.05 mg/dL (0–1.2), TSH 0.8 mUI/L (0.48–4.81), and 24-hour urinary calcium 312 mg/day (0–300).Neck ultrasonography showed a 30x15 mm hypoechoic solid nodule posterior to the left thyroid lobe, suggestive of a parathyroid adenoma, along with additional hypoechoic solid nodules measuring 25 x 10 mm at the left lobe–isthmus junction and 17x10 mm within the left lobe, which were evaluated as thyroid nodules. Parathyroid scintigraphy confirmed the suspected parathyroid lesion. Thyroid scintigraphy showed that the nodules in the left lobe had a hyperfunctioning pattern. Pelvic MRI revealed a heterogeneous mass measuring 8x5 cm, eroding almost the entire acetabulum. Bone mineral densitometry indicated severe osteoporosis (L1–L4 T-score: –3.9; femoral neck T-score: –4.2). Ultrasound showed multiple calculi in the lower pole of the left kidney, the largest 5 mm.The patient was hospitalized, started on intravenous hydration, and given zoledronic acid. She then underwent left hemithyroidectomy and left inferior parathyroidectomy. Histopathological examination of the thyroid specimen revealed follicular nodular disease. The parathyroid specimen showed irregular parathyroid parenchyma with nodular hyperplasia, and the differential diagnosis included atypical parathyroid tumor and prior biopsy tract changes. However, the patient had no history of invasive neck procedures.Postoperatively, serum calcium and PTH normalized. The patient was closely monitored for atypical parathyroid tumor, and orthopedic follow-up was planned for the brown tumor.ConclusionThis case shows a rare presentation of an atypical parathyroid tumor with a destructive brown tumor in the acetabulum. Clinicians should strongly suspect primary hyperparathyroidism in patients with unexplained osteolytic lesions, especially if labs show hypercalcemia and high PTH.

IntroductionCentral diabetes insipidus is a clinical syndrome which results from loss or impaired function of ADH secreting neurons in the hypothalamus/posterior pituitary. The syndrome is characterized by hypotonic polyuria and compensatory polydipsia. It is estimated that destruction of over 90% of the vasopressinergic neurons is necessary for the clinical syndrome. Etiology of central diabetes insipidus involves trauma, autoimmunity, as well as inflammatory and infiltrative disorders.Langerhans cell histiocytosis (LCH) is a histiocytic disorder characterized by granulomatous lesions infiltrating various tissues and organs throughout the body. LCH is a rare diagnosis in adults occuring 0.07 per million annually. Pituitary may be involved in the multisystemic form of the disease and may present as diabetes insipidus. Here we present a case with polydipsia who was found out to have multisystemic LCH.Clinical CaseA 35-year-old male patient was consulted to the endocrinology department for polydipsia. The patient had been well until three months before when he began drinking about 12 liters of water a day. He had been suffering from a slight pain in the left hip for four years that remained uninvestigated. He had a smoking history of 40 pack years. His medical history was otherwise unremarkable. Physical examination showed normal findings except a limited extension and external rotation of left hip. Laboratory tests revealed a urine osmolality of 60mOsm/kg and a serum osmolality of 287mOsm/kg. Water deprivation test was consistent with complete antidiuretic hormone (ADH) deficiency; central diabetes insipidus. Pituitary MRI showed a slight increase in the stalk thickness. Further investigation was carried out to understand the underlying disease. A high-resolution thorax computerized tomography (CT) showed peribronchial thickening, cystic enlargements and irregular reticular densities involving both upper lobes and superior segments of lower lobes. These findings suggested LCH. The bone scintigraphy demonstrated increased osteoblastic activity in right frontotemporal, posteroparietal and mandibular regions and trochanteric region of left femur. Positron emission tomography with fluorodeoxycholine showed; increased uptake in both lungs, right mandible, left femur, calvarium, right iliac bone and T2 vertebra. Bone biopsy from left femur proved the diagnosis of LCH. Desmopressin nasal spray was prescribed for ADH deficiency. Cladribine was started by the department of Hematology for Langerhans cell histiocytosis.ConclusionCentral diabetes insipidus may be a sign of a multisystemic infiltrative or inflammatory disorder. Although rare, LCH should also be considered as an underlying disorder in CDI. Careful clinical and radiologic investigation is necessary for correct diagnosis and management.Figure 1:Fluoro-Deoxy Glucose- Positron Emission Tomography (FDG-PET) Table 1:Laboratory Results

Hip involvement is a common presentation of chronic inflammatory rheumatic diseas-es. It profoundly affects patients' functional status and quality of life, reflecting a more severe disease. As the hip joint disease progresses, it can lead to severe disability. Arthroplasty is the most effective option for relieving pain and restoring function. Over the last few years, there has been a notable decrease in hip joint replacements, driven by satisfactory outcomes achieved with conservative strategies. This review summarizes the current evidence regarding the effect of available biological treat-ments on hip involvement in inflammatory rheumatic diseases. A narrative review was conducted using the PubMed database to identify case reports, case series, and original articles published up to 2024. TNFα inhibitors are effective in relieving hip involvement symptoms, maintaining satisfactory hip function, and stabilizing radiographic hip damage in patients with inflammatory rheumatic diseases. Tocilizumab seems to stop and reduce hip radiographic damage in patients with system-ic juvenile idiopathic arthritis. IL-17/IL-23 axis inhibitors are effective in relieving hip pain in pa-tients with spondyloarthritis, but their effect on hip structural damage remains unknown. Despite these promising findings, data regarding hip involvement remain scarce and limited to observa-tional studies and case series.