Hip Joint Research Articles

Influence of texting while walking on lower extremity gait function in young adults

Texting while walking (TWW) is a dual-task activity that young adults perform in their everyday lives. TWW has been reported to affect gait characteristics such as gait speed, stride length, and cadence. However, the influence of TWW on lower extremity gait function has not been investigated. Therefore, the purpose of this study was to quantify gait function by examining gait symmetry and using a time series analysis. Twenty-eight young adults (14 males, 14 females) walked at their preferred speed for 10 m as a baseline condition and a 10 m TWW task. Three-dimensional segment tracking was achieved utilizing a lower extremity and trunk marker set and the Model Statistic was used to test for statistical differences between the hip, knee, and ankle angular joint positions. The hip yielded the most asymmetries (25 out of 101 points) throughout the gait cycle, while asymmetries for the knee and ankle joints yielded 16 out of 101 points and 11 out of 101 points, respectively. The outcomes of this study suggest there are differences between baseline and TWW gait symmetry, however, the percentage of the gait cycle affected was less than 25 % - indicating gait function is not strongly influenced by texting while walking in young adults.

A Novel Personalized Strategy for Hip Joint Flexion Assistance Based on Human Physiological State.

Soft exosuits have emerged as potent assistive tools for walking support and rehabilitation training. However, most existing soft exosuit systems rely on preset assistance modes, which may not accurately align with individual physiological states and movement requirements, leading to variable user experiences and efficacy. While existing human-in-the-loop (HIL) research predominantly focuses on optimizing metabolic cost and torque difference parameters, there is a notable absence of real-time monitoring methods that closely reflect the human body's physiological state and strategies that dynamically indicate walking efficiency. Motivated by this, we developed a novel personalized power-assist system. This system optimizes the power-assist output of the hip joint by monitoring the user's physiological and motion signals in real time, including heart rate (HR), blood oxygen saturation (SpO2), and inertial measurement unit (IMU) data, to assist hip flexion based on feedback. The findings from a metabolic expenditure trial demonstrate that the innovative soft exosuit, which is based on a Physiological State Monitoring Control (PSMC) system, achieves a reduction of 7.81% in metabolic expenditure during treadmill walking at a speed of 3.5 km/h compared to walking without the assistance of the exosuit. Additionally, during continuous exercise with varying intensities, the metabolic consumption level is reduced by 5.1%, 5.8%, and 8.2% at speeds of 2, 4, and 6 km per hour, respectively. These results support the design of a novel hip flexion-assisting soft exosuit, demonstrating that applying different assistance forces in consideration of different physiological states is a reasonable approach to reducing metabolic consumption.

A composite motion control method for quadruped robots in trot gait

This work aims to address the issues of instability in trot gait walking and poor terrain adaptability in rugged environments under conventional control strategies for quadruped robots by proposing a novel composite control strategy. During the support phase, a separated force-position mixing control method is employed, utilizing gravity-compensated PD (Proportional Derivative) control at the lateral swing and knee joints while employing position control at the hip joint. During the swing phase, VMC (Virtual Model Control) is used to construct three sets of virtual spring-damper components, guiding the foot to move along a predetermined trajectory and converting virtual forces into joint torques for the swinging leg. At the body, IMU (Inertial Measurement Unit) feedback data combined with PI (Proportional Integral) control is used to adjust leg length and maintain the robot’s posture stability. Finally, the proposed separated force-position hybrid control method is theoretically validated using the Lyapunov stability criterion, and simulation tests on flat and rugged terrains under the quadruped robot’s composite control method are conducted using MATLAB/Simulink, comparing it with the VMC and position control methods. The findings indicate that the composite control strategy leads to smaller changes in the attitude angles and reduced impact forces at the feet during the quadruped robot’s walk on flat ground while also demonstrating strong adaptability to rugged terrains.

Cologne ergonomic measurement for robotic surgery (CEMRobSurg) using the Hugo™ RAS System.

The ergonomic advantages and potential challenges that robotic surgery poses to the well-being of surgeons are mainly unexplored. The most recent surgical robot introduced on the European market is the Hugo™ RAS System by Medtronic. This study aims to evaluate the ergonomic benefits of the Hugo™ RAS System, which is available in our training laboratory, CeMIT (Center for Medical Innovation and Technology Cologne). Using the previously established Cologne Ergonomic Measurement Setup for Robotic Surgery (CEMRobSurg), we measured three parameters related to ergonomic posture from subjects with different levels of surgical expertise (laypeople, medical students, surgical residents, and expert robotic surgeons). The heart rate was measured continuously using a polar band. The noise level was measured while using the Hugo™ RAS System, and automated photographs using our locally developed methodology were captured of the participant every 2s to assess body posture. The ergonomic measurements were conducted while the subject performed the same standardized robotic training exercises (Peg Board, Rope Walk, and Ring Walk). A total of 53 participants were enrolled in this study. The average noise level during all measurements was 54.87 dB. The highest stress level was measured in surgical residents with a sympathetic nervous system index (SNS index) of 1.15 (min - 1.43, max 3.56). The lowest stress level was measured in robotic experts with an SNS index of 0.23 (min - 0.18, max 0.91). We observed a risk-prone positioning of the neck and elbow in medical students (mean 39.6° and 129.48°, respectively). Robotic experts showed a risk positioning in the knee and hip region (mean 107.89° and 90.31°, respectively). This is the first study to analyze and objectify the ergonomic posture of medical students, surgical trainees, surgeons, and laypeople using the open console, modular Hugo™ RAS System. Our findings offer recommendations for operating surgeons and allow for a comparative analysis between the different robotic systems. Further evaluations in real-time operative scenarios will follow.

Preoperative SSRI use increases perioperative transfusion need in patients undergoing surgical procedures on the hip joint.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients. Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery. A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty. Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery.

Mobility Requirements and Joint Loading during Straight Walking and 90° Turns in Healthy Older People and Those with Hip Osteoarthritis.

Background/Objectives: Hip mobility and joint loading in hip osteoarthritis (HOA) patients are mostly assessed during straight walking. Yet, mobility limitations in the frontal and transverse planes are rarely found during this task in subjects with mild-to-moderate symptoms. Turning movements are frequently encountered during everyday life and might require larger hip mobility compared to straight walking, especially in the frontal and transverse planes. Thus, hip mobility and hip loading during straight walking and 90° turns in persons with HOA and healthy older adults were compared in this study. Methods: A retrospective analysis was conducted on 21 subjects with mild-to-moderate HOA and 21 healthy controls. Hip angles and moments were assessed during straight walking and 90° step and spin turns. Gait analysis was conducted using a motion capture system and a force plate. Group and movement task differences were assessed with a mixed-model ANOVA. Results: Peak abduction and adduction angles were largest during the step and spin turn, respectively, as were the group differences between HOA subjects and healthy subjects. Both turns require a greater transverse hip range of motion compared to straight walking. Limitations in transverse hip mobility in the HOA group were especially prominent during the step turn. Both turns cause higher joint moments than straight walking. Conclusions: The additional inclusion of 90° step and spin turns into gait analysis can enhance early identification of hip mobility limitations in the frontal and transverse planes in subjects with mild-to-moderate hip osteoarthritis. Early diagnosis is crucial for the timely application of conservative treatment strategies.

MulTI-domain self-management in older People wiTh OstEoarthritis and multi-morbidities: protocol for the TIPTOE randomised controlled trial

BackgroundFour out of five people living with osteoarthritis (OA) also suffer with at least one other long-term health condition. The complex interaction between OA and multiple long-term conditions (MLTCs) can result in difficulties with self-care, restricted mobility, pain, anxiety, depression and reduced quality of life. The aim of the MulTI-domain Self-management in Older People wiTh OstEoarthritis and Multi-Morbidities (TIPTOE) trial is to evaluate the clinical and cost-effectiveness of the Living Well self-management support intervention, co-designed with people living with OA, integrated into usual care, in comparison to usual care alone.MethodsTIPTOE is a multi-centre, two-arm, individually randomised controlled trial where 824 individuals over 65 years old with knee and/or hip joint pain from their OA affected joint and at least one other long-term health condition will be randomised to receive either the Living Well Self-Management support intervention or usual care. Eligible participants can self-refer onto the trial via a website or be referred via NHS services across Wales and England. Those randomised to receive the Living Well support intervention will be offered up to six one-to-one coaching sessions with a TIPTOE-trained healthcare practitioner and a co-designed book. Participants will be encouraged to nominate a support person to assist them throughout the study. All participants will complete a series of self-reported outcome measures at baseline and 6- and 12-month follow-up. The primary outcome is symptoms and quality of life as assessed by the Musculoskeletal Health Questionnaire (MSK-HQ). Routine data will be used to evaluate health resource use. A mixed methods process evaluation will be conducted alongside the trial to inform future implementation should the TIPTOE intervention be found both clinically and cost-effective. An embedded ‘Study Within A Project’ (SWAP) will explore and address barriers to the inclusion of under-served patient groups (e.g. oldest old, low socioeconomic groups, ethnic groups).DiscussionTIPTOE will evaluate the clinical and cost-effectiveness of a co-designed, living well personalised self-management support intervention for older individuals with knee and/or hip OA and MLTCs. The trial has been designed to maximise inclusivity and access.Trial registrationISRCTN 16024745. Registered on October 16, 2023.

Characteristics of clinical manifestation of acute haematogenous osteomyelitis of the bones of the hip joint in children

Aim. To study the characteristics of the clinical manifestations of acute haematogenous osteomyelitis of the hip bones in children.Material and methods. The clinical features of acute osteomyelitis of the hip joint were studied in 90 children aged between 2 and 16 years during 2017-2023. In the early stages of the disease, 9 (10.0%) patients were admitted before 3 days after the onset of the disease, and 81 (90.0%) patients were admitted later than 3 days. The proximal femoral metaepiphysis was involved in 78 (86.7%) cases, the iliac bones in 10 (11.1%), the pubic bone in 1 (1.1%) and the sacroiliac joint in 1 (1.1%).Results and discussion. Examining the clinical picture of the disease, the main symptoms were: pain in the affected area - 87 (96.7%) patients, sometimes with pain radiating to nearby areas of the body, fever - 83 (92.2%), forced position of the affected limb with refusal to walk - 79 (88.8%), and limping in 11 (12.2%) patients. In addition, purulent leakage was observed in 2 cases, in the left pubic bone lesion purulent leakage was observed in the area of the inner surface of the left thigh and in the iliac bone lesion in the iliopsoas muscle.Conclusions. Acute haematogenous osteomyelitis of the bones of the hip joint in children usually begins acutely against the background of a healthy condition of the child with a triad of symptoms: pain, increase in body temperature, forced position of the limb. Local symptoms of the disease depend on the location of the primary focus, the degree of involvement of joints and soft tissues in the process.

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

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

Changes in rotator movement during early gait acquisition in after total hip arthroplasty

BackgroundIn walking in healthy adults, rotation of the hip joint affects stride length and shifts the center of gravity, but these are not seen in hip osteoarthritis which affects gait. In gait of total hip arthroplasty, there are few reports on changes in the horizontal plane. This study clarified the preoperative and early postoperative gait characteristics of patients undergoing total hip arthroplasty. MethodsThe analysis included 12 females who underwent initial total hip arthroplasty using a posterolateral approach. Gait was measured pre and postoperatively using a three-dimensional motion analysis device. Statistics were compared pre and postoperative range of motion, muscle strength, walking speed, stride length, gravity movement distance, trunk angle, hip joint angle, and joint moment. FindingsThe maximum hip abduction moment and trunk flexion angle to the surgical side were lower than in healthy subjects. The angle of internal rotation during the stance phase was significantly higher in the postoperative period. The distance of the center of gravity shift in the left and right directions was significantly decreased postoperatively. InterpretationGait disturbance was seen preoperatively and remained after surgery. Walking after total hip arthroplasty provides the hip joint rotates inward which is closer to normal walking. However, no change was observed in the external rotation moment of the hip joint during walking. We suspect that the invasiveness of the posterolateral approach of total hip arthroplasty affects the muscles for external rotation of the hip joint. This can also cause in gait disturbances.

Morphometric Assessment of the Hip Joint in a Functional Dysplastic Rabbit Model.

The present study investigates the morphometric changes in the hip joint in a surgically induced rabbit model of hip dysplasia through the sectioning of the ligamentum capitis femoris and pelvic limb immobilization. A total of seventeen rabbits were evaluated using radiographic and computed tomographic imaging to measure the following parameters: the femoral angles of anteversion and inclination, length and width indexes of the neck of the femur, and acetabular depth and ventroversion. Significant differences in femoral anteversion angle and acetabular depth were observed, particularly in the group of hip instability surgery with pelvic limb immobilization. The results have shown the influence of hip joint instability in the promotion of femoral anteversion and acetabular shallowing. These findings provide a foundation for future research on naturally occurring or experimentally induced hip dysplasia in rabbits and underscore the model's potential for studying the biomechanical and developmental aspects of hip joint disorders.

Insights into Hip pain using Hip X-ray: Epidemiological study of 8,898,044 Koreans

Hip pain is a prevalent degenerative joint symptoms, imposing a significant global health burden. Hip pain is experiencing an increase in incidences in Korea due to its aging society, and the social burden of hip pain continues to rise as the hip joint is crucial for gait and balance. This study assessed the epidemiology of hip pain in Korea using data from the fifth version of Korea National Health and Nutrition Examination Survey (KNHANES V-5). The research analyzed data from 8,898,044 Koreans to evaluate the prevalence and characteristics of hip pain and abnormal hip X-ray. Variables encompassed medical, demographic, mental, social, and musculoskeletal factors. Descriptive analysis and propensity score matching analyses unveiled characteristics of Koreans experiencing hip pain or showing abnormal hip x-ray. The study provides insights into the epidemiology of hip pain in the entire Korean population, and further suggesting the effective management of hip pain.

Evaluation of finite element modeling methods for predicting compression screw failure in a custom pelvic implant.

Introduction: Three-dimensional (3D)-printed custom pelvic implants have become a clinically viable option for patients undergoing pelvic cancer surgery with resection of the hip joint. However, increased clinical utilization has also necessitated improved implant durability, especially with regard to the compression screws used to secure the implant to remaining pelvic bone. This study evaluated six different finite element (FE) screw modeling methods for predicting compression screw pullout and fatigue failure in a custom pelvic implant secured to bone using nine compression screws. Methods: Three modeling methods (tied constraints (TIE), bolt load with constant force (BL-CF), and bolt load with constant length (BL-CL)) generated screw axial forces using functionality built into Abaqus FE software; while the remaining three modeling methods (isotropic pseudo-thermal field (ISO), orthotropic pseudo-thermal field (ORT), and equal-and-opposite force field (FOR)) generated screw axial forces using iterative physics-based relationships that can be implemented in any FE software. The ability of all six modeling methods to match specified screw pretension forces and predict screw pullout and fatigue failure was evaluated using an FE model of a custom pelvic implant with total hip replacement. The applied hip contact forces in the FE model were estimated at two locations in a gait cycle. For each of the nine screws in the custom implant FE model, likelihood of screw pullout failure was predicted using maximum screw axial force, while likelihood of screw fatigue failure was predicted using maximum von Mises stress. Results: The three iterative physics-based modeling methods and the non-iterative Abaqus BL-CL method produced nearly identical predictions for likelihood of screw pullout and fatigue failure, while the other two built-in Abaqus modeling methods yielded vastly different predictions. However, the Abaqus BL-CL method required the least computation time, largely because an iterative process was not needed to induce specified screw pretension forces. Of the three iterative methods, FOR required the fewest iterations and thus the least computation time. Discussion: These findings suggest that the BL-CL screw modeling method is the best option when Abaqus is used for predicting screw pullout and fatigue failure in custom pelvis prostheses, while the iterative physics-based FOR method is the best option if FE software other than Abaqus is used.

Efficacy of Real-Time Feedback Exercise Therapy in Patients Following Total Hip Arthroplasty: Protocol for a Pilot Cluster-Randomized Controlled Trial.

Osteoarthritis of the hip joint is an increasing functional and health-related problem. The most common surgical treatment is hip replacement to reduce pain and improve function. Rehabilitation after total hip arthroplasty (THA) is not regulated in Austria and mostly depends on the patient's own initiative and possibilities. Functional deficits, such as valgus thrust of the leg, functional Trendelenburg gait, or Duchenne limp, are characteristic symptoms before and, due to the performance learning effect prior to surgery, also after the operation. Addressing these deficits is possible through neuromuscular-focused exercise therapy. The efficacy of such therapy relies significantly on the quality of performance, the frequency of exercise, and the duration of engagement. Enhancing sustainability is achievable through increased motivation and real-time feedback (RTF) on exercise execution facilitated by digital feedback systems. This study will be performed to quantify the medium-term effectiveness of digital home exercise feedback systems on functional performance following THA. A clinical trial with a cluster-randomized, 2-arm, parallel-group design with an 8-week intervention phase and subsequent follow-ups at 3 and 6 months postsurgery will be conducted. Feedback during exercising will be provided through a blended-care program, combining a supervised group exercise program with a self-developed digital feedback system for home exercise. In total, 70 patients will be recruited for baseline. The primary outcome parameters will be the frontal knee range of motion, pelvic obliquity, and lateral trunk lean. Secondary outcomes will be the sum scores of patient-reported outcomes and relevant kinematic, kinetic, and spatiotemporal parameters. The trial started in January 2024, and the first results are anticipated to be published by June 2025. RTF-supported home exercise is expected to improve exercise execution quality and therapeutic adherence compared to using paper instructions for excise guidance. The anticipated findings of this study aim to offer new insights into the effect of a blended-care program incorporating digital RTF on exercise therapy after unilateral THA, in addition to knowledge on the functional status 3 and 6 months postsurgery, for further improvement in the development of rehabilitation guidelines following THA. ClinicalTrials.gov: NCT06161194; https://clinicaltrials.gov/study/NCT06161194. PRR1-10.2196/59755.

Enhancing tribological performance of high‐density polyethylene polymer with diamond‐like carbon coating and mollusk shells filler

AbstractThis study explores the tribological properties of mollusk‐shell‐high‐density polyethylene (MS‐HDPE) biocomposites and diamond‐like carbon (DLC)‐coated metal beads as potential substitutes for hip joint prostheses. HDPE biocomposites with 0, 5, and 10 wt% of MS were developed using hot compression molding. Coatings included pure DLC, DLC‐Si, and DLC W:H. Wear tests on a ball‐on‐disk tribometer examined friction and wear rates against coated and uncoated balls, along with wear morphology. MS‐HDPE demonstrated superior tribological performance against DLC, achieving a 67% reduction in specific wear rate compared to pure HDPE. The study suggests that 5 wt% MS‐HDPE coupled with a DLC‐coated counterpart coating could be a promising combination for orthopedic applications, presenting a potential solution to metal corrosion and wear debris issues in orthopedic implants.Highlights Tested coatings: DLC, DLC‐Si, and DLC W:H. Biocomposite wear versus coated balls. DLC coating improves wear with shell fillers. Mollusk shell strengthens biocomposites. Reduced wear rate by 63% and friction by 77%.

The utilization of the Vezzoni modified Badertscher distension device in breeding programs: Heritability estimates and effect on the hip dysplasia prevalence.

Canine hip dysplasia (CHD) is a common orthopedic condition, influenced by both genetic and environmental factors. While current breeding programs often rely on ventrodorsal hip-extended (VDHE) radiographs, it is known they fail to accurately assess hip joint laxity. Therefore additional laxity-oriented diagnostic techniques have been developed. This study aims to evaluate the effectiveness of the Vezzoni modified Bädertscher distension device (VMBDD) technique, which quantifies hip joint laxity with the laxity index (LI), as a screening tool in two breeding programs. Data from a Belgian population of assistance dogs (population A) and a French population of guide dogs (population B) were analyzed. The heritability estimates of the LI, estimated using Bayesian statistical methods, were high in both populations (0.83 in population A and 0.82 in population B). Improved screening of parents by combining the VMBDD technique with the VDHE, significantly decreased LI and the prevalence of CHD in their offspring. In population A, when two parents were screened with the VMBDD compared to one, there was an average LI decrease of 0.03 (P<0.05). In population B, when one or both parents were screened with the VMBDD compared to none, the average LI decrease was 0.04 (P< 0.05) and 0.05 (P<0.01), respectively. In population A, screening both parents with the VMBDD in addition to the VDHE, resulted in 82.7% (P< 0.05) lower odds of CHD compared to screening only one parent. In population B, screening one parent led to 72.3% (P<0.05) lower odds of CHD compared to none of the parents being screened. In population B, when both parents were screened with the VMBDD, not a single case of CHD was observed in the puppies. In conclusion, based on these results, the VMBDD technique has the potential to drastically reduce CHD prevalence and is as such an excellent tool for breeding programs.

Hip joint motion amplitude control based on exponential product formula

Background: Handball is a team sport, and during a game, there is a lot of direct squabbling and close contact between the players. Objective: The goal of the research is to determine how handball training affected several aspects of physical fitness. The study also investigates the relationship between playing handball, passive hip range of motion (ROM), and the development of radiologically detectable hip osteoarthritis (OA) in formerly elite handball players. The research employed the exponential product algorithm for evaluating bilateral radiographs to classify and diagnose hip OA. This technique most likely evaluated subchondral sclerosis, osteophyte formation, joint space narrowing, and other radiological signs of OA in the individuals’ hip joints. Methods: The relationship among the risk of hip OA in long-term top handball players is explored, as well as the connections among hip ROM, OA, and pain. The research was conducted using a sample size of 20 ex-professional handball players and 39 control subjects. Information on demographics, loading patterns during exercise, and history of lower limb joint injury were gathered via a questionnaire. The inclusion criteria for individuals consisted former professional handball players with significant elite-level competitive experience, as well as control subjects with no background of high-impact sports. Confounding characteristics such as age, gender, and previous lower limb joint injuries were carefully controlled for using extensive demographic and injury history evaluations. To identify and categorize hip OA, bilateral radiographs were analyzed using the exponential product algorithm. The goniometer was used to assess the bilateral passive hip ROM. Long-term participation in elite handball at a high level was found to have a strong correlation with the hip development of osteoarthritis (OA). Sixty percent of handball players had been identified with OA in at least one hip joint, compared to only thirteen percent of control patients. Results: Hip flexion and medial rotation in the handball players were significantly decreased, whereas abduction, extension, and lateral rotation were increased considerably compared to the control values. When doing daily activities, the hip joints of the handball players with OA were less painful than those of the OA-afflicted control participants. Retired handball players seem to be at a much higher risk than the general population for developing early hip OA. Conclusion: The repetitive nature of handball-specific movements may result in anomalies that are seldom seen in the general population, which makes diagnosing pain and discomfort a challenging diagnostic challenge for sports physicians.

THE EVALUATION OF TOTAL HIP ARTHROPLASTY IN THE MANAGEMENT OF SPASTIC PAINFUL HIP DISLOCATION IN CEREBRAL PALSY

Spasticity used to be considered a contraindication for total hip replacement (THR) procedures. Due to the development of implants as well as surgical skills, THR became an option for the treatment of painful dislocation of the hip joint in patients with spastic plegia. The aim of this study was an evaluation of mid-term results of THR in spastic CP adolescent patients with painful hips with hip joint subluxation or dislocation.In 2014–2022, 18 pts (19 hips) with CP aged 16 to 20 years underwent THR in our department. The mean follow-up was 4 years (range: 1 – 9 years). Results were evaluated using the Gross Motor Function Scale, VAS scale in accordance with the Ashworth scale, types of implants used (dual mobility cup and not dual mobility cup), and radiological assessment (Crowe scale). Complications have been thoroughly analyzed.In 10 pts there has been an improvement in the GMFSC scale average from 1 to 2 points observed after the surgery. All pts have improved in the VAS scale average of 8 points (from 10 to 7). According to the Crowe scale repositioning of preoperative dislocation to primary acetabulum was achieved in all cases. Complications occurred in 4 cases: dislocations of 2 THR with dual mobility cup and 2 THR with non-dual mobility cup requiring revision surgery with good final result. No statistical significance was noted according to the type of cup (Mann-Whitney U Test).The most important risk factor for complications is severe spasticity. We believe, that CP pts with painful hips should be treated using THR. We didn't observe any significant differences between the types of implants.These findings may serve as a basis for the prediction of outcomes of THR treatment in this specific group of pts.Level of evidence: Case-control or retrospective comparative study-Level III

The Impact of Physiotherapy on a patient with Ankylosing Spondylitis Following Bilateral Total Hip Replacement: A Case Study

Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disorder primarily affecting the axial skeleton, with a prevalence of approximately 0.25% in India, predominantly in males. This case study explores the physiotherapeutic management of a 35-year-old male patient underwent bilateral Total Hip Replacement and presented with primary complaint of progressive stiffness in the back and neck region along with pain in his right hip joint. Outcome measures included Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS), and Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) with significant improvements observed over 12 weeks: BASFI improved from 7 to 2, BASDAI from 8.1 to 3.8, VAS pain from 8 to 3, and HOOS, JR score from 40 to 60. The results demonstrate that AS-specific exercises combined with a home-based exercise protocol can significantly enhance pain management, functional capacity, disease activity and hip disability in AS patients.

Native hip geometry restoration in total hip arthroplasty: a retrospective analysis of eight different short stems.

To compare different types of short stems (SS) in terms of native hip geometry reproducibility, analyzing centrum-collum-diaphyseal angle (CCD) and femoral offset (FO). These parameters allow the SS to be adapted to patient's anatomy in order to ensure better functional outcomes in total hip arthroplasty (THA). A total of 387 cases of SS met the inclusion criteria. CCD and FO were measured using MediCAD® software Version 6 in preoperative (preop-) and postoperative (postop-) X-rays at 6-12months after surgery. Considering preop-CCD, the sample was divided into three groups: ≤ 124.9° (A); 125°-129.9° (B); and ≥ 130°(C). Preop- and postop-CCD and FO and the respective average difference (Δ) were examined considering the SS individually and within groups, to verify reproducibility of these parameters. The SS considered were eight: Fitmore Zimmer, Pulchra Adler, TRIS Adler, Trifit Corin, Trilock Depuy, Actis Depuy, Profemur Microport, and SMF Smith&Nephew. Groups A, B, and C consisted, respectively, of 113, 124, and 150 cases. Considering all cases, there was a statistically significant (p < 0.05) increase in CCD and FO with surgery. Overall, Trifit and Trilock stems were the best in reproducing preop-CCD, Trifit itself followed by Pulchra and Profemur for preop-FO. In groups A and C, the reproduction of preop-CCD was better than preop-FO, in contrast in group B. With regard to preop-CCD reproduction, in group A Trifit and Pulchra, in group B Fitmore and Trifit, and in group C Fitmore and Pulchra were the best. Fitmore in group A, SMF in group B, Pulchra and Trilock in group C were the worst in reproducing preop-FO. Each hip anatomy is unique, and reproduction of preop-CCD and preop-FO can be achieved with different SS characteristics. Accurate knowledge of the stems and performing correct preop- planning are crucial to allow the best restoration of the patient's native hip geometry in THA.