Sided Hip Pain Research Articles

Bare area on the trochanter and its correlations to gluteal tendon insertion dimensions

Gluteus medius and minimus tears have recently been reported to be very common and the main etiology of lateral sided hip pain. The purpose of this study was to determine whether there is any correlation between the dimensions of the tendon insertions and bare areas (BA) and various bony landmarks. Twenty-seven hemipelvises from adult male hips were included. The bony landmarks [anterior tip (Ta), posterior tip of trochanter, vastus tubercle (VT) and center of BA] were marked. The longitudinal lengths and widths (maximum) of posterosuperior (PS), lateral facets (LF), minimus insertion (Min) and BA and the distance between posterior (Tp) and Ta and between anterior/posterior tips and the VT or center of BA were measured using a digital caliper. A correlation analysis was performed between variables. There was a correlation between LFlength and Minlength (r = 0.4, P = 0.01) and between Ta–BA and PS + LF (r = 0.5, P = 0.003) or Minlength (r = 0.4, P = 0.016). LFwidth was negatively correlated with BAwidth (r = −0.4, P = 0.002). Tp–BA was negatively correlated with BAwidth (r = −0.4, P = 0.01). LFwidth was correlated with Tp–BA, and this nearly reached statistical significance (r = 0.3, P = 0.05). BA can be used intraoperatively as landmarks to estimate the width of the LF and also to determine the length of the longitudinal insertion of the gluteus medius and minimus tendons.

Pseudotumor mimicking iliacus muscle abscess following a total hip arthoplasty with metal on metal articulation

Rationale:Cases of pseudotumor complicated after THA with metal-on-metal articulation as a bearing surface have been reported. Most of the pseudotumors occurred near or inside the hip joint, and usually have similar features with the infectious condition. We herein report a case of pseudotumor with huge size in the pelvic cavity mimicking features of iliacus muscle abscess.Patients concerns:A 70-year-old female was referred to our emergency department due to huge mass in her right pelvic area on abdominal CT. She complained of mild febrile sensation, generalized weakness, and pain in her right leg for several months. The patient underwent metal-on-metal bearing THA 11 years ago for treatment of right-sided hip pain due to avascular necrosis.Diagnosis:Percutaneous catheter drainage was performed for both therapeutic and diagnostic reasons. No microbes were cultured from the drained fluid, and signs of chronic inflammation were shown on pathology slide samples. The patient showed positive allergic reactions to cobalt and captan on allergic patch test, and serum cobalt levels was increased as 46.78 μg/L (normal value, 0.11–0.64 μg/L). Biopsy samples of the cyst were consistent with the histological findings of pseudotumor reported by Willert et al.Intervention:For the treatment of infection, primarily, the patient was surgically treated by irrigation, debridement, and bone bead insertion. Then, after 4 weeks of antibiotic treatment, revision surgery changing the metal-on-metal articulation into poly-on-metal articulation was performed.Outcomes:CT scan at 1 year after surgery showed no findings of cyst inside the pelvic cavity. Although the patient complained of right sided hip pain (VAS score 2), she was able to perform activities of daily living.Lessons:In patients who underwent metal-on-metal THA, pseudotumor mimicked the feature of periprosthetic infection may occur not only inside the hip joint but also in the pelvic cavity.

Brucella Sacroiliitis in Thalassemia Major

To the Editor: A 17-y-old boy was admitted with fever, right sided hip pain and limping since 2 mo. He had been under treatment for thalassemia major since the age of 1 y with regular RBC transfusion and iron chelation. Physical examination revealed fever and limitation of right hip movement. Laboratory evaluation revealed; hemoglobin 10.2 g/dL, platelet count 807×10/L, white blood cell count 16.1×10/L. Biochemical tests were normal. C-reactive protein was 7.3 mg/dL; erythrocyte sedimentation rate was 32 mm/h. Serological tests for hepatitis A, B, C; HIV, HSV, EBV, CMV, parvovirus B19, toxoplasmosis were negative. Rheumatologic tests -ANA, rheumatoid factor, ANCAwere normal. Brucella standard tube agglutination test was positive at a titer of 1/640. Magnetic resonance imaging showed right sacroiliitis. Brucella was isolated from the blood and since sacroiliitis is a well known osteoarticular manifestation of brucellosis, a diagnosis of brucella sacroiliitis was made. The patient was given the specific antibiotic treatment with the combined regimen of streptomycin, doxycycline and rifampicin; he showed progressive improvement of symptoms to complete recovery. Brucellosis is an infectious disease which can present with varied clinical pictures. The signs and symptoms are usually not specific to the disease and it is often misdiagnosed. Osteoarticular involvement is very common and the frequency varies from 10–85 % [1, 2]. During the course of thalassemia major; various musculoskeletal abnormalities can be encountered due to marrow hyperplasia and extramedullary hematopoiesis either due to the disease or transfusion and iron chelation treatments [3, 4]. In our patient the diagnosis was delayed because patient’s complaints were thought to be related with thalassemia major and the iron chelation treatment. We present this case to highlight that brucellosis should be included in the differential diagnosis of childhood osteoarticular manifestations in endemic countries even if there is a multisystemic illness that could explain the condition.

Surgical Repair of Chronic Tears of the Hip Abductor Mechanism

Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores.Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of Oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery.We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.