Study of lower limb inter-joint coordination during gait of the patients with early-stage osteonecrosis of the femoral head.

Hip Pain in a Patient With Traumatic Brain Injury and Complex Fractures: A Clinical Vignette.

Bernese Peri Acetabular Osteotomy-A Review Article.

Iliopsoas strengthening increases hip joint forces during gait: A simulation study.

Exploring the link between brucellosis and osteonecrosis: A scoping review of current evidence.

Background Venous-Origin Chronic Pelvic Pain (VO-CPP), a subgroup of Pelvic Venous Disorders (PeVD) can significantly affect Quality of Life (QoL). Previous papers have highlighted the lack of evaluations measuring QoL of patients before and after embolization. The aim of this study was to evaluate the effectiveness of embolization in reducing a variety of symptoms and improving QoL in patients with VO-CPP. Methods A prospective analysis of 40 female patients (mean 36.9 years) diagnosed with VO-CPP, undergoing venous embolization between June 2020 and May 2023 was conducted. Patients with extrinsic compressions, other pelvic conditions, and S3V3 without S2 in SVP Classification were excluded. Patients were evaluated before and after treatment at mid-term (MT) (9.4 ± 5.1 months) and long-term (LT) (29.6 ± 6.94 months). The severity of 12 different symptoms were assessed using VAS scale (pelvic, postcoital, standing, back, hip, leg and abdominal pain; nausea frequency, urinary discomfort, sleep disturbance and dysmenorrhoea), while QoL was measured using the SF-36 questionnaire. Patient satisfaction was assessed using the Likert scale. Results Significant reductions in all measured symptoms were observed between pre-treatment and MT and LT follow-ups (p < 0.0001). No statistically significant differences were found between MT and LT scores, indicating a sustained relief. The greatest benefits were observed in reducing daytime pelvic pain (6.25 ± 1.93 to 2.49 ± 2.47), standing (7.43 ± 1.65 to 3.41 ± 2.43) and postcoital pain (6.40 ± 2.63 to 2.54 ± 2.22). QoL scores in both physical and mental health showed statistically significant and sustained improvement after the procedure. Most patients were satisfied with the procedure (81%), with 86% willing to undergo it again and 89% to recommend it. Conclusion Embolization provides significant, sustained improvements in symptom relief while enhancing QoL in VO-CPP patients. Randomized controlled trials are needed to confirm these effects and exclude a placebo response.

Background Existing classification systems for sequelae of pediatric septic arthritis of the hip (SAH) are notably complex. This study introduces a simplified radiographic classification—the Xi’an Honghui Hospital Paediatric Orthopaedic Classification (HHPO classification)—designed to enhance accuracy in treatment planning and prognostic evaluation. Methods A retrospective analysis was conducted involving 18 pediatric patients with SAH. Pelvic radiographs were evaluated to assess the structural integrity of the femoral head and neck and their spatial relationship with the acetabulum. Based on these assessments, the HHPO classification was developed. Six independent observers classified each case using both the HHPO and Choi systems. Interobserver reliability and two-week intraobserver consistency were assessed and compared between the two classifications. Results The distribution according to the HHPO classification was as follows: Type IA (n=5), Type IB (n=6), Type ID (n=2), Type IIA (n=3), and Type IIB (n=2). The HHPO system demonstrated significantly higher inter- and intraobserver agreement compared to the Choi classification. Clinically, severe hip pain was reported in 5 patients, occasional pain in 2, and no pain in 11. The majority of hips (88.9%) exhibited satisfactory range of motion, and 72.2% were radiologically stable. Earlier onset of infection was associated with more severe sequelae. Conclusion The HHPO classification is simpler, more reproducible, and demonstrates potential clinical utility for managing pediatric SAH sequelae in this cohort.

Current guidelines are split on the role that imaging has in the clinical assessment of osteoarthritis, yet clinical computed tomography (CT) imaging has now revealed how a 3D approach can improve prediction of total hip replacement (THR) over 2D measures alone. We applied 2D grading and measurement along with 3D cortical bone mapping to ordinary clinical CT imaging of the pelvis in a cohort of healthy older people, aiming to discover which of these features had clinical utility in predicting total hip replacement (THR) within 8 years and which were related to baseline hip pain. Using a nested case-control design in the AGES-Reykjavik study, 74 future THR cases were age and sex-matched with 184 controls from the cohort (age 74±5yrs). Baseline assessment involved a validated hip pain questionnaire and pelvic CT. The following were performance-tested using ROC analysis and Clinical Utility Index: (i) hip pain; (ii) Kellgren and Lawrence grade (K&L grade), (iii) minimum joint space width (mJSW); and (iv) 3D cortical bone thickness (CTh). The clinical utility index for prediction of future THR from baseline pain was poor at 0.28, with the inclusion of imaging improving this to 0.79 (K&L grade) and 0.82 (3D CTh). Self-reported hip pain at baseline was also a poor-to-marginal predictor of THR (AUC=0.63), but 3D cortical thickening at the femoral head was predictive of future THR (0.81). Having radiographic osteoarthritis strongly predicted THR irrespective of hip pain (0.85). Combining hip pain, K&L grade and 3D cortical thickness gave optimal prediction (0.88). Ascertainment bias may have occurred if primary care physicians requested their own radiographs of their patients' hips. Imaging features from standard clinical CT identifies patients at high risk of progression to surgery for osteoarthritis, regardless of baseline pain.

Fatigue fractures occur due to repetitive submaximal mechanical stress on bone and are most common in the lower extremities of endurance athletes and military recruits. This report details a rare case of bilateral anterior acetabular-superior pubic ramus junction fatigue fractures in a marathon runner presenting with low back and hip pain. MR imaging of the pelvis was initially interpreted as normal. Further review by a sports medicine physician and a musculoskeletal radiologist prompted an addendum identifying bilateral mild marrow edema of the anterior acetabula with incomplete fracture line on the left and near complete fracture line on the right. Multiple factors may have contributed to the initial missed diagnosis, including the rarity of the stress fracture location and symmetry, the subtlety of the imaging findings, and the atypical clinical presentation often associated with pelvic stress fracture development. Additionally, the patient's infection with SARS-CoV-2 prior to fatigue fracture formation may have played a pathologic role due to muscular deconditioning as well as disrupted bone metabolism. The subacute fracture pattern described in this report should be recognized by radiologists on MR imaging to avoid the potentially debilitating consequences of progression and exacerbation of fatigue fractures in endurance athletes.

Reactive arthritis is defined as a sterile inflammation of the joint space, following a remote infection, which can be bacterial or viral in origin. Although leptospirosis is not a frequent cause, it has been reported as a potential trigger. We herein report an 11-year-old boy who presented with fever, jaundice, and acute onset of right hip pain with restricted movement. Laboratory investigations were done to evaluate for infectious causes. IgM antibodies for Leptospira were equivocal, suggesting the possibility of an acute infection. This case highlights that reactive arthritis can develop early in the course of leptospiral infection, as early as within 3 days of symptom onset, and may coincide with active systemic illness. Early recognition of this rare association is essential for the diagnosis and management.

Bone marrow edema (BME) of the femoral head is a prevalent condition that can cause hip pain and is observed in patients as a standalone finding or in conjunction with degenerative or inflammatory conditions. There has been a lack of extensive study on the effectiveness of combining surgery with biological treatment for BME. The objective of this study was to evaluate the efficiency of core decompression (CD) with bone marrow aspirate concentrate (BMAC) augmentation in alleviating pain and enhancing the quality of life in patients with BME in the hip. We conducted a retrospective analysis of patients who underwent treatment for BME of the hip using CD combined with BMAC between June 2021 and July 2023. Inclusion criteria consisted of patients diagnosed with BME in the hip (presence of BME on T2-weighted MRI in the femoral head or neck with pain corresponding to the same compartment as the BME). The patients' demographic information, presence of other medical conditions, body mass index (BMI), etiology, and assessments using the visual analog scale (VAS) and Harris hip score (HHS) were recorded. Pre- and postoperative radiographic imaging (XR) and magnetic resonance imaging (MRI) were analyzed. This study included 28 patients (40 femoral heads) who underwent CD with BMAC grafting at our institution. Among these patients, 9 had normal or non-diagnostic radiographs, 11 were at ARCO stage Ⅰ, and 8 were at ARCO stage Ⅱ. The mean age at the time of operation was 45.21 years (SD 13.17, range 21-75), and the mean BMI was 24.61 (SD 3.75, range 16.6-32.05). The area of BME showed a significant decrease from 954.21 ± 224.68 mm2 to 162.21 ± 189.05 mm2 3 months following surgery (P < 0.001). The VAS showed a substantial reduction from 4.86 ± 1.24 points to 1.86 ± 1.27 points at 3 months post-surgery, and further decreased to 1 ± 1.68 points at 12 months post-surgery (P < 0.001). HHS increased from 48.14 ± 4.4 points to 72.79 ± 8.96 points at 3 months after surgery and further increased to 86.39 ± 11.82 points at 12 months after surgery (P < 0.001). Two patients experienced the resolution of BME 3 months following surgery, whereas 3 femoral heads of 3 patients with ARCO 2 stage collapsed. Treatment of BME of the hip using CD combined with BMAC is effective and provides short-term pain relief for BME.

BackgroundChronic hip pain, the second most common cause of lower-extremity musculoskeletal pain, significantly affects life and health. It is often linked to anxiety and depression, impacting treatment outcomes. However, prior research on the psychological status of such patients is limited.ObjectiveTo explore the correlation between chronic hip pain and patients' psychological cognition.MethodsA retrospective cross-sectional study was conducted.The first study evaluated patients with chronic hip, knee, and ankle pain hospitalized from June to December 2024, recording general info, assessing pain with VAS and PSQ, and psychological status with SAS and BDI.The second study assessed chronic hip pain outpatients from November 2023 to July 2024, categorized by pain source, and recorded relevant data.ResultsIn the first study with 25 patients, hip group had significantly higher SAS and BDI scores than ankle and knee groups (P < 0.01).In the second study with 72 patients, combined intra- and extra-articular pain patients had higher BDI and SAS scores than those with single-source pain.ConclusionChronic hip pain patients have more significant psychological disorders. Different pain sources lead to varying anxiety and depression levels. Clinicians should emphasize psychological factors and strengthen intervention for specific patients.

IntroductionFemoroacetabular impingement (FAI) is one of the most common diagnosis made for hip pain. The 2016 Warwick Agreement defined the term FAI as a triad of symptoms, clinical signs and imaging findings. The main symtpom of FAI is motion-related or position-related pain over the hip with a history of vigorous or supra-physiologic activity, seated workstyle. Clinical signs usually consist of FADIR, FABER, passive ROM test and reproduce similar pain episodes when impinged. Diagnostic imaging should contain hip joint plain films of anteroposterior view to rule out other casues of hip pain, and an advanced imaging with CT or MRI for better morphology understanding. Despite evaluation through symptoms and signs, physical exam, diagnostic imaging, acetabulum or proximal femur cancer may present similarly to FAI, which can lead to serious consequence if delayed treatment.Case presentationWe present seven cases with initial presentation similar to FAI and eventually turned out to be tumor. There are five males and two females, two losses to follow-up and no pathology proof were made. Hip pain was presented at all cases, FADIR test was negative in one case. Final diagnosis consists of osteoid osteoma, chondrosarcoma, metastatic lung, breast and cecal cancer.Discussion & ConclusionsThe diagnosis of FAI relies on the symptoms, physical examinations, and radiologic evaluation. However, clinical pitfalls mimicking FAI such as neoplasms should be taken into consideration. Our cases demonstrated metastatic cancers initially manifested as hip pain and misdiagnosed with FAL Thus, we put an emphasis on proper evaluation and diagnosis towards the patients suffering from hip pain.

BackgroundFunctional performance tests are frequently utilized to evaluate individuals with lower extremity pain. Patients with hip pain commonly report difficulty and pain with activities of daily living, such as squatting or sitting in a chair. The purpose of this study was to examine the differences in inter-limb loading during a double leg squat in patients with hip pain.MethodsPatients with a primary complaint of hip pain presenting to a hip preservation clinic were included. Two force plates capturing at 1000 Hz were used to assess kinetics during a double leg squat, performed to a depth as low as comfortable at a rate of one squat every two seconds with a five second rest between repetitions. A total of three squats were performed and averaged. Paired T-Tests were utilized to compare the involved and uninvolved limbs’ concentric and eccentric peak forces during the double leg squat.ResultsA total of 43 subjects (23.39±1.52 years, 28 females) were included for analysis. On average, subjects demonstrated decreased eccentric loading of the involved limb (M = 437N, SE = 102N), compared to the uninvolved limb (M = 449 N, SE = 107 N). This difference, 12 N, was statistically significant, t(42) = 1.863, p = .035, and represented a small effect of d = 0.284. On average, subjects demonstrated decreased concentric loading of the involved limb (M = 454 N, SE = 115 N), compared to the uninvolved limb (M = 462 N, SE = 117 N). This difference, 8 N, was not statistically significant, t(42) = 1.271, p = .105, and represented a trivial effect of d = 0.194.ConclusionPatients presenting with hip pain demonstrated unequal loading of their involved hip during a double leg squat. The involved limb demonstrated significantly less eccentric loading, while there was not a significant difference in concentric loading. This disparity in limb loading during a double leg task may indicate an altered motor pattern due to pain aversion or weakness. Clinicians should consider that patients presenting with hip pain may demonstrate off-loading of their involved limb during double leg tasks.

Abstract Background The short version International Hip Outcome Tool (iHOT-12) has been utilized to predict baseline factors that influence outcomes of hip arthroscopy, as well as to assess the success of patients after hip arthroscopy. However, few studies have evaluated which variables are predictors of baseline iHOT-12 scores. The purpose of this study was to determine which clinical factors predict baseline iHOT-12 scores in patients who present with a chief complaint of hip pain. Methods Patients were retrospectively identified from a single surgeon, prospectively collected database. Patients with a complete iHOT-12 questionnaire and unilateral hip pathology were included. Demographic and radiographic data, as well as medical history were recorded. Variables included age, duration of symptoms, current or past history of anxiety/depression, low back pain, whether a specific event was associated with hip pain inception, radiographic osteoarthritis, and whether the primary diagnosis was intra-articular or extra-articular. Descriptive statistics were run for demographics and medical history. A multiple linear regression was conducted to determine which baseline factors are predictive of baseline iHOT-12 scores. Statistical significance was accepted at an alpha level of &amp;lt;0.05. Results A total of 319 subjects were included (average age: 30.02 ± 11 years; 237 females, 82 males). Four variables were found to negatively influence iHOT-12 scores at baseline. Increases in BMI (β= -0.744, p=&amp;lt;0.001), presence of an intra-articular diagnosis (β = -7.99, p=0.02), female sex (β= -6.39, p=0.008), and patient reported history anxiety/depression (β= -5.36, p=0.013) were all associated with decreases in iHOT-12 scores at initial visit. Age, duration of symptoms, presence of low back pain, osteoarthritis, and whether a specific event was associated with hip pain inception were not significant predictors of baseline iHOT-12 scores. Conclusion An increased BMI, intra-articular diagnosis, female sex female, and patient-reported history of anxiety/depression negatively impacted baseline iHOT-12 scores in patients presenting with a chief complaint of hip pain. These findings underscore the importance of assessing these patients holistically and identifying both modifiable and unmodifiable factors that affect their hips.

IntroductionLongstanding hip and groin pain can arise from intra- and extraarticular sources, and individuals suffering from these conditions are often referred to orthopedic care. While physical therapist-led interventions are recommended in guidelines, optimal delivery for this patient population is unknown. The aim of this trial is to determine the effectiveness of a structured physical therapist treatment model (HIPSTER) compared to usual care for people with longstanding hip and groin pain referred to orthopedic care, regardless of source of symptoms.Methods and AnalysisThis pre-registered study protocol for a double-blinded two-armed pragmatic randomized controlled trial adheres to SPIRIT guidelines. Patients with longstanding hip and groin pain (n=122), referred to an orthopedic department in Sweden, will be recruited and randomized into usual care (control) or the HIPSTER model (experimental). The HIPSTER model is a 16-week structured, individualized progressive treatment provided by trained physical therapists, using exercise therapy and patient education. Usual care consists of a recommendation to undergo physical therapy in primary care, but the intervention will not be controlled by the researchers. Both intervention groups will undergo standard diagnostic procedure at the orthopedic department, including imaging, clinical examination and diagnostic injection. The main outcome will be mean change in iHOT-33 from baseline to the primary end-point at 4 months. Secondary outcomes include patient reported outcomes and physical performance tests. An orthopedic surgeon will conduct a surgical consultation with the participants after the primary end-point. Further follow-up points will be 1, 2 and 5 years post randomization. Sub-groups of the main RCT will also complete semi-structured interviews and report additional data on psychosocial variables.ImplicationsThis project will provide valuable information on people with longstanding hip and groin pain, a patient group that commonly suffer delays in diagnosis and suboptimal treatment pathways. If effective, implementing the treatment model in primary care can potentially lead to improved clinical outcomes and use of societal resources.

BackgroundAlthough os acetabuli (OSA) has been recognized since a long time ago, there are still some controversies regarding its cause (unfused ossification center, acetabular rim fracture, labral ossification) and how to differentiate them. There is also no previous study that evaluated the prevalence of OSA in asymptomatic population. The aim of this study was to investigate; 1) the prevalence, size and location of os acetabuli (OSA) in general population; 2) differentiation between the characteristic types of OSA: unfused ossification centers, rim fractures and labral ossifications; 3) correlation between OSA, and femoroacetabular impingement (FAI) with symptoms.MethodsWe retrospectively reviewed images from 5684 patients who underwent abdominal and pelvic Computed-Tomography (CT) images in 2016 with non-orthopedic indications in 2016 (asymptomatic group) and images from 264 patients who underwent hip arthroscopy surgery from 2010 to 2016 in our institution (symptomatic group). Two investigators evaluated these images to find the prevalence of OSA, distribution of its size and location, its relationship with hip pain and FAI. We also correlated them with the types of OSA based on previous literatures (unfused ossification center, rim fracture, labral ossification and loose bodies).ResultsThe prevalence of OSA in symptomatic and asymptomatic groups were 8.65% (25/289) and 3.3% (378/11356), respectively. The distribution of OSA types were labral ossifications (55.1%), rim fractures (33.5%), unfused ossification center (1.2%) and others (7.9%). Male predominance was found in all type of OSA. Labral ossification had the smallest size and mostly was asymptomatic. Rim fracture was correlated with FAI in general (90.3%; p<0.005), but not with any specific types of FAI. Size of OSA had a significant relationship with symptom (895.28 vs. 103.64 mm3; p<0.001).ConclusionThe prevalence of OSA in general population are 3.46%, with significantly higher prevalence of OSA were found in symptomatic group (8.65% vs. 3.3%). Labral ossification was the most common OSA type. Significant relationship was found between rim fracture and general FAI but not with any specific types of FAI. Size of the OSA was significantly associated with hip pain.

IntroductionIliopsoas (IP) tendinitis is a common cause of hip pain. It has been reported that physical examination (PE) of the hip has limited utility to diagnose IP tendinitis. Differentiating anterior hip pain due to IP tendinitis from intra-articular sources is critical to appropriately treat patients with hip pain. This study was designed to ascertain if PE is reliable in detecting IP tendinitis.MethodsThis retrospective cohort included patients diagnosed with IP tendinitis by an orthopedic surgeon and treated with ultrasound-guided injection of corticosteroid and anesthetic by a sports physiatrist between 2011 and 2024. Patients with PE findings consistent with IP tendinitis —including weakness with seated hip flexion (SHF), pain with SHF, and tenderness to palpation (TTP) of the IP were referred for ultrasound-guided injection. A positive response to injection was defined as >50% pain relief. Hip MRIs obtained within one year of diagnosis were also reviewed for signs of IP tendinitis (e.g., edema or bursal fluid). This study was IRB approved.Results135 injections in 105 patients were identified. Mean age was 41.2 years (SD: 15.4; range: 15.6–76.8), and 74.8% were female. Mean follow-up was 4.0 years (SD: 2.35; range: 0.35–13.41). In 105 instances (77.8%), patients had a positive response to injection. Absolute SHF weakness had the highest sensitivity at 96.2% and PPV of 77.1%, though specificity and NPV were zero. SHF weakness relative to the contralateral side had sensitivity of 82.2%, specificity 24.1%, PPV 79.0%, and NPV 28.0%. Pain with SHF had sensitivity 76.1%, specificity 22.2%, PPV 76.9%, and NPV 21.4%. Absolute TTP had sensitivity 92.6% and PPV 74.6%. Relative TTP had sensitivity 86.6%, specificity 18.5%, PPV 76.3%, and NPV 31.2%. Among 72 cases (53.3%) with MRI, 13 (18.1%) showed abnormalities. MRI sensitivity was 19.2%, specificity 85.0%, PPV 76.9%, and NPV 28.8%.ConclusionsIP tendinitis can reliably be detected on PE, specifically with SHF and palpation of the IP tendon. The high sensitivity and PPV of these tests support their use as screening tools in the evaluation for IP tendinitis. MRI offers high specificity but limited sensitivity in the diagnosis of IP tendinitis.

A 21-year-old woman presented with a six-month history of right hip pain, which was notably exacerbated at night. Plain radiographs revealed no specific abnormalities. However, computed tomography (CT) identified a 5-mm nidus located at the anterior aspect of the right acetabulum. Magnetic resonance imaging (MRI) demonstrated a well-defined, low signal intensity lesion on T1-weighted images and high signal intensity surrounding bone marrow edema on T2-weighted images, findings consistent with osteoid osteoma. Whole-body bone scintigraphy (WBBS) showed a focal area of intense radiotracer uptake at the corresponding site.Based on CT findings, the lesion site was preoperatively marked on X-ray, and arthroscopic tumor excision was planned. Under C-arm guidance, an anterolateral portal was established, followed by an anterior portal. Extensive capsulotomy was performed to enhance device mobility. Although the osteoid osteoma was not directly visualized during arthroscopy, excision, including the overlying articular cartilage, was performed while confirming the lesion location with intraoperative C-arm imaging.Postoperatively, the patient’s right hip pain and night pain showed significant improvement. However, she developed meralgia paresthetica symptoms due to lateral femoral cutaneous nerve (LFCN) injury. This was managed with two ultrasound-guided LFCN blocks at the anterior superior iliac spine (ASIS) level at one-week intervals, resulting in symptom resolution.

IntroductionPatients with hip pain present with a variable level of symptoms and a wide range of diagnoses. Symptom severity affects referral frequently, whereas, treatment decisions are more dependent on specific diagnosis. The correlation between presenting symptom severity and actual diagnosis is unclear and has an impact on perception of need for care as well as shared decision-making.The purpose of this study is to use a large, prospective database in order to correlate pre treatment outcome measures with diagnosis at the time of consultationMethodsAs part of a previously reported study on hip pain in adults, 1,004 patients underwent comprehensive examination, radiographic analysis and collection of outcome data including a modified HHS and iHOT-12. Primary and secondary diagnoses were identified and then correlated with presenting outcome measures or presence of hypermobility by ANOVA. Correlations between outcome scores and diagnoses were re-evaluated to identify which scores were better predictors of disease.ResultsPatients presenting with labral tears reported significantly lower iHOT score (less pain in the past month) than patients with other diagnoses (p=0.04). FAI patients showed no difference reporting on HHS or iHOT except for the hypermobile group which had a significantly reduced incidence (p=0.04) of Cam Type impingement. However, that difference is lost when Pincer and Mixed Type are considered. The data confirmed our previous analysis with a strong correlation (p<0.01) between hypermobility and dysplasia but added that this population was significantly less likely to have OA (p<0.01). There was a significant increase of HHS score in patients with Dysplasia (p<0.01) and FAI (p<0.01) compared to other groups. A similar result was observed with iHot scoresConclusionsSeverity of symptoms on presentation using accepted outcome measures correlates with the diagnosis at the time of presentation to a hip specialty clinic. Patients with conditions most amenable to arthroscopic and open hip preservation surgery (FAI and DDH) have higher iHOT and mHHS scores than patients with established diagnosis of osteonecrosis and osteoarthritis. Since Milder symptoms are seen in patients with dysplasia and FAI, delay in referral may be more common.